Hey guys before we get started with today's lesson let me know in the comments below if
you find pharmacology to be just overwhelming. I'm expecting a lot of yeses just so you know.
What I get a lot from my students is how do I remember all the different names of drugs and the
key is you don't. You learn it by classification and that's why we're going to talk about-
one classification of antibiotics today known as the carbapenems.
What's great about learning drugs by classification is that you can then
put together pieces of information so that you don't have to memorize a list of drugs
you'll be able to identify them quickly. Now not all classifications have that added bonus but the
one we're talking about today carbapenems does, so let's get to the board and we'll start the lesson.
Welcome back my name is Tammy and this is NurseMinder and on this channel,
we do everything nursing so if you're new here consider subscribing below so
that you get the next video when it's released. When it comes to recognizing
which drugs are in the carbapenem classification that's an easy one they all end in penEm p-e-n-e-m
and so there's no need to memorize a name for the classification of carbapenem because then when you
see it in an exam, for example, your patient is on meropenem - you go AH! that's a carbapenem and
this is what I remember about carbapenems. So the first thing I want you to know is
there's a lot of hints in the name. I love me a good name! Okay I think carbs;
carbs are both good for us because we need them for our cellular function, it's the fuel for our
brain and they are building blocks of steroids, hormones. and so carbs are good for our body.
That's the gram-positive. Carbs as you might already have guessed are also
negative for our body. When we eat too much we gain weight, we become sluggish, so
that's how I remember that carbapenem is both for gram-positive and gram-negative bacteria;
but here's something you need to know. Unlike carbs as we consume them through our mouth we eat;
carbapenems are not given orally; just the opposite they are given intramuscularly and
intravenously. So when you think of carbs there's another clue in terms of carbapenems
while they are both for gram-positive and gram-negative, we do not consume them,
we have them done parental parentally through IM and IV injections. Awesome right! Okay
let's get back to the board. We have another clue inside the word and that's the letter p
When it comes to carbapenem where do they work? They work in the polyribosomal part of the cell
that's your p, and what do they do? Is they change protein function to your second p in order to
prevent cell division so let me write that out for you. Okay so here we have it summarized.
The site of action is polyribosomes where it will change protein function
in order to prevent cell division. That's a lot of words to say that it inhibits cell
division it creates cell death, but if you need to remember where it works we've got a clue in the
name 'p' polyribosomes. We know it's protein we know it's going to prevent cell division boom bam!
Okay so here's a quick visual of how carbapenem can be so easily dissected. So number one we have
the suffix when you're looking for a generic name that shows up in one of your NCLEX questions and
your patient might be on meropenem you know right away it's a carbapenem because the ending, that
the suffix is the same as the classification. The site of action is the p - so in the polyribosomes
where it changes protein function in order to prevent cell division which results in cell death.
Awesome now carbs remember carbs are both good and bad so it's good on gram-positive & gram-negative
but despite carbs; how we take them orally; we're actually going to take them intravenously and
intramuscularly, they are not an oral medication in fact these are used for quite a long time
typically five to 14 days because of the serious infections that we use them for. So let's talk
about a few more pieces. Guys if this is making sense to you and this is like light bulb, light
bulb, light bulb and you're like 'I can remember this!' Let me know with an emoji below because
learning should be fun and I really try to bring out the um the little things the nuances of a word
to help you remember them. So let's get back to the board. Now because this is a broad-spectrum
antibiotic remember gram-positive & gram-negative, the list is long as to what it will treat.
You want to always be checking your culture and sensitivity. Now it's possible your patient will
be started on an antibiotic before we get those results in and what you'll be looking for then
is the patient's response to the treatmen. Is the infection getting better. So if it's a, if it's a
skin wound are you seeing a decreasing a shrinking of that swelling and redness? Are there changes in
their white blood cell count on their lab results? What is it that you're seeing that's actually
identifying that this drug is working until we get our culture and sensitivity report back.
If you have it you'll want to check it to make sure that this drug has been identified
as something that the infection will respond to. Now because the list is so long I wanted to give
you one, one reason why your patient would not be on a carbopenem and that is MRSA. That is a
really common diagnosis that we see Methicillin resistant staph aureus; your patient would not
be on a carbapenem. Now anytime we use antibiotics we have to be worried about the fact that not only
do they wipe out the bad bacteria but they also wipe out the good bacteria and when we think of
that we think of our gut. In our stomach we have a lot of bacteria that are good for us to help
protect us but when we decrease the numbers of those we're at risk of clostridium difficile uh
shortened as c diff which is a lot of poo. Okay so diarrhea is one of the side effects of any
antibiotic. Now this one in particular also has a side effect that you need to be aware
of and that is pseudomembranous colitis. So what happens is we get these inflamed areas of yellow
plaque and it inhibits the ability of the colon to absorb nutrients and so and then we end up
being dehydrated and have electrolyte imbalances as a result. So when you think of carbs think of
bloated think of how you feel when you eat too many and then think about inside your colon and
how that is also causing this bloated yellow plaques to start to develop. Now one really
important contraindication and again this is coming from our clues in the words. I want to
go back to carbs. What happens when you don't have enough carbs? Have you ever felt Hangry?
Like you're starting to shake and sweat and feel like I've got to have something to eat. i want you
to remember that because one of the most important contraindications is patients who have a history
of seizure disorders, it can actually decrease the threshold of seizures which means it will increase
the impact or the the volume of seizures that they have. okay so think carbs when I'm really low and
I'm shaky connect that to seizures - don't give them carbapenem because it's going to actually
increase the risk of seizures for them. So with that I think it's time for our NCLEX question.
Okay as the nurse you are preparing to administer imipenem cilastatin 500 milligrams IV every 6
hours for septicemia. What lab test would confirm that this is the appropriate medication for this
patient? a) white blood cell count b) a culture insensitivity c) cholesterol levels d) hemoglobin
Now that you've paused the video and you've come back if you answered b) culture and sensitivity
you would be correct. It is true that the white blood cell count may be elevated but that is not
a confirmation for the medication. We need to do a culture and sensitivity.
Well done. Okay here are physician write an order for ertapenem one gram daily orally for 10 days.
As the nurse reviews this order what would be the priority action? 1) Call the pharmacy
to make sure the drug is available 2) Assess the patient to ensure they can swallow pills 3) Call
the physician to revise the order for an IM or IV prescription or D) assess the patient wound prior
to administration to document any changes. Go ahead and pause and make your selection.
If you have selected to call the physician to revise the order you would be correct because
carbapenems are only given intramuscularly intravenously and not orally. I just want to
show you have done some great work watching this video and committing those little elements and
those tips and tricks to memory so that when you come up to a question in your nursing exam you're
going to be able to nail it! Well done! You now I really appreciate you watching and supporting
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off your phone or go back to work just yet or maybe even turn the lights off to go to sleep so
why don't you spend a little bit more time here watching another video. :)