{"id":101,"date":"2019-09-22T17:51:38","date_gmt":"2019-09-22T17:51:38","guid":{"rendered":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/chapter\/3-7-carbapenems\/"},"modified":"2025-01-16T22:25:07","modified_gmt":"2025-01-16T22:25:07","slug":"3-7-carbapenems","status":"publish","type":"chapter","link":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/chapter\/3-7-carbapenems\/","title":{"raw":"3.7 Carbapenems","rendered":"3.7 Carbapenems"},"content":{"raw":"Carbapenems are a beta-lactam \u201ccousin\u201d to penicillins and cephalosporins.\n\nMechanism of Action:<\/strong> Carbapenems are typically bactericidal and work by inhibiting the synthesis of the bacterial cell wall.\n\nIndications:<\/strong> Carbapenems are useful for treating life-threatening, multidrug-resistant infections due to their broad spectrum of activity.[footnote]Papp-Wallace, K. M., Endimiani, A., Taracila, M. A., & Bonomo, R. A. (2011). Carbapenems: Past, present, and future. Antimicrobial Agents and Chemotherapy, 55<\/em>(11), 4943\u20134960. https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3195018\/<\/a>[\/footnote]<\/sup> These antibiotics are effective in treating gram-positive and gram-negative infections. Because of their broad spectrum of activity, these medications can be especially useful for treating complex hospital-acquired infections or for clients who are immunocompromised.\n\nNursing Considerations:<\/strong> Considerations for carbapenems are similar to those for cephalosporins. Cross-sensitivity may occur in clients allergic to penicillin or cephalosporins.\n\nSide Effects\/Adverse Effects:<\/strong> Common side effects of carbapenems include gastrointestinal upset, including nausea, vomiting, and diarrhea. Additional adverse effects include injection site reactions, skin rash, and pruritis.\n\nHealth Teaching & Health Promotion: <\/strong>Clients should monitor for signs of superinfection (such as vaginal itching or discharge indicating a yeast infection or loose or foul-smelling stool indicating C-diff) and report any occurrence to the provider. If a client experiences fever and bloody diarrhea, they should contact the provider immediately. The client should also be advised that side effects can occur even weeks after the medication is discontinued.[footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]<\/sup>\n\nNow let's take a closer look at the medication grid for imipenem in Table 3.7.[footnote]This work is a derivative of DailyMed<\/a>\u00a0by\u00a0U.S. National Library of Medicine<\/a> in the\u00a0Public Domain<\/a>. [\/footnote]\u00a0<\/sup>\n\nTable 3.7 Carbapenem Medication Grid\n\n\n\n\n
\n
Class\/Subclass<\/strong><\/h5>\n<\/th>\n
\n
Prototype\/Generic<\/strong><\/h5>\n<\/th>\n
\n
Nursing Considerations<\/strong><\/h5>\n<\/th>\n
\n
Therapeutic Effects<\/strong><\/h5>\n<\/th>\n
\n
Side\/Adverse Effects<\/strong><\/h5>\n<\/th>\n<\/tr>\n
Carbapenems<\/th>\nimipenem<\/a><\/td>\nRoute: IV\n\nCheck for allergies, including penicillin and cephalosporins\n\nDosage adjustment if renal impairment\n\nUse with caution with seizure disorder or renal dysfunction<\/td>\nMonitor for systemic signs\u00a0of infection:\n\n-Increased WBCs\n\n-Fever\n\nMonitor actual site of infection\n\nMonitor culture results, if obtained<\/td>\nSimilar to cephalosporins<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n \n
\n

Critical Thinking Activity 3.7\"Image<\/h2>\n<\/header>\n
Using the above grid information, consider the following clinical scenario question:<\/strong><\/span><\/div>\nA client was admitted to the hospital with a serious abdominal infection. The nurse notices that this client has a history of a previous severe allergic reaction to penicillin while preparing to administer the first dose of imipenem medication. What is the nurse\u2019s next best action?\n\nNote: Answers to the Critical Thinking activities can be found in the \u201cAnswer Key<\/a>\u201d section at the end of the book.\n\n \n\n<\/div>","rendered":"

Carbapenems are a beta-lactam \u201ccousin\u201d to penicillins and cephalosporins.<\/p>\n

Mechanism of Action:<\/strong> Carbapenems are typically bactericidal and work by inhibiting the synthesis of the bacterial cell wall.<\/p>\n

Indications:<\/strong> Carbapenems are useful for treating life-threatening, multidrug-resistant infections due to their broad spectrum of activity.[1]<\/sup><\/a><\/sup> These antibiotics are effective in treating gram-positive and gram-negative infections. Because of their broad spectrum of activity, these medications can be especially useful for treating complex hospital-acquired infections or for clients who are immunocompromised.<\/p>\n

Nursing Considerations:<\/strong> Considerations for carbapenems are similar to those for cephalosporins. Cross-sensitivity may occur in clients allergic to penicillin or cephalosporins.<\/p>\n

Side Effects\/Adverse Effects:<\/strong> Common side effects of carbapenems include gastrointestinal upset, including nausea, vomiting, and diarrhea. Additional adverse effects include injection site reactions, skin rash, and pruritis.<\/p>\n

Health Teaching & Health Promotion: <\/strong>Clients should monitor for signs of superinfection (such as vaginal itching or discharge indicating a yeast infection or loose or foul-smelling stool indicating C-diff) and report any occurrence to the provider. If a client experiences fever and bloody diarrhea, they should contact the provider immediately. The client should also be advised that side effects can occur even weeks after the medication is discontinued.[2]<\/sup><\/a><\/sup><\/p>\n

Now let’s take a closer look at the medication grid for imipenem in Table 3.7.[3]<\/sup><\/a>\u00a0<\/sup><\/p>\n

Table 3.7 Carbapenem Medication Grid<\/p>\n\n\n\n\n
\n
Class\/Subclass<\/strong><\/h5>\n<\/th>\n
\n
Prototype\/Generic<\/strong><\/h5>\n<\/th>\n
\n
Nursing Considerations<\/strong><\/h5>\n<\/th>\n
\n
Therapeutic Effects<\/strong><\/h5>\n<\/th>\n
\n
Side\/Adverse Effects<\/strong><\/h5>\n<\/th>\n<\/tr>\n
Carbapenems<\/th>\nimipenem<\/a><\/td>\nRoute: IV<\/p>\n

Check for allergies, including penicillin and cephalosporins<\/p>\n

Dosage adjustment if renal impairment<\/p>\n

Use with caution with seizure disorder or renal dysfunction<\/td>\n

Monitor for systemic signs\u00a0of infection:<\/p>\n

-Increased WBCs<\/p>\n

-Fever<\/p>\n

Monitor actual site of infection<\/p>\n

Monitor culture results, if obtained<\/td>\n

Similar to cephalosporins<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

\n
\n

Critical Thinking Activity 3.7\"Image<\/h2>\n<\/header>\n
Using the above grid information, consider the following clinical scenario question:<\/strong><\/span><\/div>\n

A client was admitted to the hospital with a serious abdominal infection. The nurse notices that this client has a history of a previous severe allergic reaction to penicillin while preparing to administer the first dose of imipenem medication. What is the nurse\u2019s next best action?<\/p>\n

Note: Answers to the Critical Thinking activities can be found in the \u201cAnswer Key<\/a>\u201d section at the end of the book.<\/p>\n

 <\/p>\n<\/div>\n

  1. Papp-Wallace, K. M., Endimiani, A., Taracila, M. A., & Bonomo, R. A. (2011). Carbapenems: Past, present, and future. Antimicrobial Agents and Chemotherapy, 55<\/em>(11), 4943\u20134960. https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3195018\/<\/a> ↵<\/a><\/li>
  2. uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a> ↵<\/a><\/li>
  3. This work is a derivative of DailyMed<\/a>\u00a0by\u00a0U.S. National Library of Medicine<\/a> in the\u00a0Public Domain<\/a>. ↵<\/a><\/li><\/ol><\/div>","protected":false},"author":83,"menu_order":6,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[48],"contributor":[],"license":[],"class_list":["post-101","chapter","type-chapter","status-publish","hentry","chapter-type-numberless"],"part":82,"_links":{"self":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/101","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/wp\/v2\/users\/83"}],"version-history":[{"count":1,"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/101\/revisions"}],"predecessor-version":[{"id":102,"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/101\/revisions\/102"}],"part":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/parts\/82"}],"metadata":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/101\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/wp\/v2\/media?parent=101"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/chapter-type?post=101"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/wp\/v2\/contributor?post=101"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/wp\/v2\/license?post=101"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}