Beta-Lactam Antibiotics: Carbapenems and Monobactams (Nursing)

00:01 Now we're going to move on to another of the drugs in the beta-lactam family, the carbapenems.

00:08 Imipenem, meropenem, ertapenem, and doripenem.

00:10 Those are just 4 examples of the generic names in the carbapenem family.

00:15 Remember, carbapenems have the same mechanism of action.

00:19 They weaken the bacterial cell wall and you'll see that icon on the slide.

00:23 And they are part of the beta-lactam family because they also have a beta-lactam ring.

00:29 Now, carbapenems are very broad spectrum.

00:34 I always like to think of this as a car wreck that would be majorly traumatic, and that's why they treat very broad spectrum. So, carbapenems are very, very broad-spectrum drugs.

00:46 They're not active against MRSA. That would be awesome if they were, but remember, we have already been introduced to a drug that can treat MRSA in the fifth generation cephalosporins.

01:00 Now, the adverse effects for carbapenems -- no drug is without some type of adverse effect, GI distress and possible allergic reaction.

01:09 Those are pretty consistent across the board, and I know you've heard me say that before, but I want to help you recognize if you're thinking about antibiotics, pretty much, any of them can cause GI distress and you're at risk for an allergic reaction.

01:23 Now, carbapenems, because they are so broad spectrum, can put your patient at risk for a superinfection.

01:29 Now, superinfection is not super good.

01:32 In fact, it's super bad.

01:35 Because it's broad spectrum, it knocks out lots of different kinds of bacteria.

01:41 Sometimes, it knocks out the good bacteria, so you may be treating a patient for 1 infection, but a superinfection is another infection that develops because of the antibiotics we gave you. See, when you knock out too many bacteria, now, all of a sudden, there's lots of resources available for the bad bugs that don't help us.

02:01 And that's what a superinfection is called.

02:05 So, 1 example you may be familiar with.

02:07 If you are a female or you know a female, sometimes when they take an antibiotic, they end up with a yeast infection in a very personal space.

02:16 That's an example of a superinfection.

02:20 Now, there's a low risk of a cross allergy to penicillins, but because carbapenems also have a beta-lactam ring, you still have a low risk of a cross allergy to penicillin.

02:31 Cross allergy to penicillin means if I'm allergic to penicillin, there's a small chance that I will also have an allergy to carbapenems because it's called a cross allergy, and the beta-lactam ring structure that they share.

02:45 Now let's take a look at monobactams.

02:47 Monobactams, in comparison to carbapenems, are much more narrow spectrum.

02:54 They only go against gram-negative aerobic bacteria.

02:58 Hey, why is that super cool? Well, remember, gram-positive is slower, kinder, gentler kind of bugs. We can kill them easier.

03:08 Gram-negative are tougher to kill.

03:11 So monobactams are great at killing gram-negative, but it has to be given IV or IM because it's not absorbed in the GI tract.

03:22 Now, here's another tip I would give you.

03:24 As you're studying for pharmacology, whenever you see something that says it has to be given IV or IM, you should almost start a separate list in your notes to make sure you have that listed there.

03:36 That's a good way to group or chunk information together.

03:41 Now, the adverse effects for monobactams are similar to another drug we've just discussed, thrombophlebitis, or pain at the injection site.

03:48 Now does it happen very often? Usually, no.

03:51 But it's something -- if you have any patient that's receiving an IV medication, it's part of excellent nursing care to frequently check that IV site, make sure that you don't see any pain or swelling or tenderness at the site because any drug or medication or fluid that we're giving in an IV site has the potential to either slide out of the vein or be caustic to the tissue around it.

04:14 So, if you assess a site, it shouldn't feel warm, and if you touch it, the patient should not feel any significant pain.

04:22 If either 1 of those 2 things are present, then you're going to need to reassess that site, and possibly start a new IV.