so mechanisms of drug resistance so what this is referring to is how the body is drug resistant how we become resistant to drugs so the drug does not reach the target site of action is basically what that is saying so some antibiotics don't penetrate into the site of infection such as lung bone absence abscesses just depends on where that affection is at the drug is not active so remember we've talked about first pass effect we only have so many active metabolites after that drug if we take it orally has gone through that first pass effect maybe the target is altered so maybe we have become or the patient has become resistance to antibiotic therapy and how could that happen well if an antibiotic is prescribed for a virus or maybe the patient does not completely take the full course of their antibiotics these are examples as to how we have now become resistant to antibiotic therapy so how do we decrease the risk what do we do well maybe our providers can be more proactive about prescribing antibiotic therapy when it's actually truly needed and we as nurses can educate our patients the same you know this is western medicine right i can order my starbucks before i get to l street and go to the wild and it's ready for me i can walk in pick it up i want it right now it's there and i go to class right we are pretty much that way about everything we do we want it right now so if we're sick and we're not feeling well we want that magic pill that's going to make it go away so the struggle is real when we look at how our providers have to talk to and educate our patients talk to the mommy or daddy that has the sick kiddo that wants medications to fix that baby right now right and so sometimes having that conversation is hard it can become a very confrontational conversation and oftentimes the medication is just prescribed right to get the people out the door so um more so it's about being a little more firm about the rationale as to why we're not prescribing it in order to protect your patients in the long run general definitions bacterial cyto if this if a drug is a bactericidal so it's important to remember the difference between these okay um for a bactericidal the kill it kills bacteria okay so this particular class of drug will kill the bacteria if the drug is a bacteriostatic it doesn't actually kill the bacteria but it does inhibit its growth okay broad versus narrow spectrum coverage broad coverage drugs are active against numerous types of organisms right so like gram-positive gram-negative anaerobic um and then narrow spectrum coverage is only effective against maybe only a few organism so that's why we really rely upon that culture and sensitivity to help aid the treatment to be able to target a specific organism general principles for all anti-microbial agents so indications as to why the rationale behind why we're administering that particular drug is what's going to help choose the correct drug for our providers so some general principles continued are the side effects pretty well known that just about all antimicrobial agents have some type of gastrointestinal or gi side effect it's pretty common among all agents nausea vomiting diarrhea stomach and abdominal cramping is um one of them so we just want to make sure that um we're really aware as an indication as to why our patient is getting the medication and that we do a really good job about educating about the gi effects that can occur so it's really important that you remember all of the mic the general principles for these antimicrobial agents so moving along precautions um we have antibiotics that will actually decrease the effectiveness of oral contraceptive agents that is so very important to be educating our mommies about is letting them know that they need to probably take a second form of a contraceptive while they're on antibiotics because it will decrease the effectiveness all have the potential of causing a secondary super infection so remember we talked about how amazing antibiotics are right they kill bacteria the problem is that not only do they kill the good or sorry the bad bacteria they also kill the good right so they might kill off that normal flora allowing for the patient to develop a super infection or a secondary infection contraindications would be sensitivity or an allergy to any of the drug classes so if the patient was allergic to any specific antimicrobial drug class that would be a contraindication to administer that particular drug class for nursing actions we want to make sure again that we are ensuring an accurate allergy list all the time allergic reactions on continuum so basically we're just wanting to make sure that we assess what the allergies are and what the reaction is to the allergy or to that medication as well what the allergic reaction is so if they say they're allergic to penicillin well what happens when you take penicillin do you get a rash high shortness of breath all those things are important making sure we follow the wbc trend and possibly symptoms um for response so we're looking at how that patient is responding to the medication is the symptomology worsening or are they actually getting better what's our white count look like are we moving the white count in the right direction meaning we're not climbing and going up um those types of things follow cns results for appropriateness of antimicrobial treatment so we are the ones as nurses who get hold of that culture and sensitivity so we want to make sure that we're paying attention to those labs because more than likely our provider has empirically treated the patient right and so we need to make sure we're looking out for that cns to come back so we can notify the provider whether or not that particular antimicrobial agent is actually sensitive to the bug we have identified