Disease States and Treatments Test 3 Flashcards by Amy Johnson

What are the most common risk factors for infective endocarditis?

Prosthetic valve and previous endocarditis

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What are the most common causes of endocarditis and the adherence mechanisms of each?

Staph= glycocalyx
Strep= dextran

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What are the most common risk factors for a Staph endocarditis?

1st year of prosthetic valve, IV drug users

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What are the most common risk factors for endocarditis caused by Enterococci?

genitourinary or obstetric procedures

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What are the most common risk factors for gram negative endocarditis?

IV drugs users, prosthetic valves, cirrhosis

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Peripheral stigmata

Seen in endocarditis
Osler nodes, splinter hemorrhages, petechiae, Janeway lesions, Roth spots, clubbing
“FROM JANE”

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Clinical criteria for diagnosing endocarditis?

2 “major” criteria= (+)ECG + persistent bacteremia w/IE pathogens
1”major” and 3 “minor” criteria= persistent bacteremia OR (+) echo + fever, eye hemorrhages, + Osler nodes
5 “minor” criteria

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Treatment for highly susceptible and relatively resistant Strep endocarditis

Highly susceptible:
Native valve: PCN G (12-18M)
Prosthetic: PCN G (24M)+ Mandatory 2 week gentamicin
Relatively resistant: PCN G + 2 week gentamicin

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Tx for highly resistant Strep and susc. enterococci endocarditis

ampicillin + 4-8 weeks of gentamicin

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Tx for endocarditis

LOOK AT TABLE IN NOTES

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First line therapy for acute otitis media

HIGH-DOSE amoxicillin (90 mg/kg/day) x 5-10 days

**If that doesn’t work w/in 48-72 hours –> HIGH DOSE amox/clav (Augmentin)

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First line therapy for acute sinusitis

Standard dose amox-clav

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Drugs of choice in acute pharyngitis (Strep throat)

penicillin OR amoxicillin x 10 days

PCN allergy: azithromycin x 5 days

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First line for acute bronchitis

USUALLY SELF LIMITING

If sx >1 week –> azithro/clarithromycin, doxy, or FQ

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Place of care based on PSI score

0-70= outpatient
71-90= outpatient or brief inpatient stay
91 - >130= inpatient

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CURB-65 criteria

Confusion, Urea 30, SBP, Age >65
0-1= outpatient
3-5= inpatient (4-5 can be ICU)

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First line outpatient therapy for CAP

Previously healthy: macrolide
Recent abx thx or cormorbid conditions: Resp FQ
Suspected aspiration: amox/clav
Flu w/ the CAP: oral BL or resp FQ

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First line inpatient therapy for CAP

Medical ward: Resp FQ

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First line inpatient ICU therapy for CAP

Need to cover MRSA!
BL+ Azithro OR Resp FQ
Need to cover pseudomonas? Antipseudomonal BL + Resp FQ
Allergy to penicillins? Aztreonam

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Gold standard for diagnosis of HCAP

lung biopsy (however generally reserved for pediatric or immunosuppressed pts)

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Risk factors for MDR pathogens

Abx w/in 90 days, current hospitalization >5 days, high abx resistance in community, immunosuppression, RISK FACTORS FOR HCAP

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Risk factors for HCAP

Hospital stay >2 days w/in the last 90 days, nursing home, home infusion tx, chronic dialysis, home wound care, family w/MDR pathogen

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“early onset” pneumo

<5 days after admission; need to cover Strep pneumo, H. flu, MSSA, and PEcK

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“late onset” pneumo

> 5 days after admission; need to cover all early onset pathogens PLUS MRSA, pseudomonas

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First line tx for early onset HCAP with no risk factors for MDR pathogens

ampicillin/sulbactam, ceftriaxone, FQ, ertapenem

First line tx for late onset HCAP with risk factors for MDR pathogens

MRSA COVERAGE + ANTIPSEUDOMONAL BL + ANTIPSEUDOMONAL AG OR FQ MRSA coverage is always vanc or linezolid

What is the most common portal of entry for osteomyelitis?

Contiguous (47%) or vascular insufficiency (34%)

Lab and Radiologic tests for osteomyelitis

inc WBC, inc ESR/CRP Need blood culture, blood culture, and joint aspiration to get diagnosis (superficial cultures are NOT reliable) MRI and bone scan can detect changes very early

First line treatment in hematogenous osteomyelitis

Children/ Sickle Cell pts: nafcillin + cefotaxime OR ceftriaxone Adults: nafcillin IV users: vancomycin + anti-pseudomonal

First line treatment in contiguous osteomyelitis/ vascular insufficiency

pip/tazo, cefepime + metronidazole (+ Vanc for MRSA) x AT LEAST 4-6 weeks

Non-pharm therapy for osteomyelitis

surgical debridement, hyperbaric oxygen therapy

What is the most common kind of infectious arthritis?

Hematogenous (seeding from systemic infection)

Clinical features of gonococcal and nongonococcal infectious arthritis

SEE CHART IN LECTURE

Treatment for infectious arthritis

Children/adults: nafcillin + cefotaxime OR ceftriaxone | Prosthetic joint, surgery, or IV users: vanc + antipseudomonal

Duration of treatment for infectious arthritis

Nongonococcal: 2-3 weeks Gonococcal: 7-10 days

Types of Diarrhea

Acute: 14 days Chronic: >4 weeks

Which types of E. coli are in watery diarrhea?

Enterotoxigenic and enteropathogenic

First line treatment for diarrhea

FLUID REPLACEMENT/ oral rehydration therapy

Examples of anti-motility agents

diphenoxylate, loperamide | DO NOT USE IN INFLAMMATORY DIARRHEA

Example of absorbent

Kaolin-pectin/aluminum hydroxide

When do you recommend antibiotics in diarrhea?

usually not indicated! | only for use in Shigella, Campylobacter, and Yersinia

Diagnosis of C. diff

stool culture and at least one toxin test (ELISA)

Treatment for initial infection of C.diff

Mild-Mod= metronidazole PO Severe= vancomycin PO Severe, complicated= vanc PO + metronidazole IV

Treatment for relapse of C. diff

1st relapse= same agent that you used on initial infection according to severity >2nd relapse= vancomycin (taper)

Bismuth subsalicylate

use in traveler's diarrhea inhibit enterotoxin activity and prevent diarrhea do not use for >3 weeks or in prego

Antimicrobials for traveler's diarrhea

usually not needed | DOC is FQ (Cipro or Norfloxacin)

Main causative organism in Primary CAPD

S. aureus

Causative org in primary SBP

E. coli

Main causative org in secondary peritoneal disease

polymicrobial: E. coli, Bacteroides, and Candida can be seen

Source Control

Antibiotics alone are not enough to treat secondary intra-abdominal infections!! Need to drain infected foci, abscesses, and fluid collections and do surgical repair of damage (seldom used in primary infections)

Treatment of primary CAPD

Gram (+) coverage (cefazolin or vanc) + Gram (-) coverage (aminoglycoside, FQ)

Treatment of primary SBP

cefotaxime, ceftriaxone, FQ

Treatment of secondary intra-abdominal infections

CA, mild-mod risk: ticarcillin/clavulanate, cefoxitin, ertapenem, metronidazole + ceph CA, high risk: pip/tazo, antipseudomonal carbapenems

Aminoglycosides PD

CONCENTRATION DEPENDENT | Peak conc 8-10X the MIC of the pathogen

beta-Lactams PD

TIME DEPENDENT | 40-50% of the time >MIC

MIC Creep

MIC's are rising for some org which makes it harder to meet target in some agents

Vancomycin PD

``` TIME DEPENDENT (troughs are assoc w/ efficacy) AUC/MIC >400 ```

FQ PD

CONCENTRATION DEPENDENT Gram (-)= AUC/MIC >125 Gram (+)= AUC/MIC >33.7

Loading Dose for Vancomycin

for pts with SEVERE illness 25-30 mg/kg IV x 1 Max 2000 mg (2 grams)

Maintenance Dose for Vancomycin

15-20 mg/kg/dose using ABW (max 2 gr) | Q8-12H based on renal function

SIRS Criteria (did I already put these on here? I can't even remember anymore #pharmacyschoolprobs)

``` HR >90 RR >20 Temp >38 (>100.4) WBC >12,000 NEED > OR = 2 OF THE 4 CRITERIA ```

Sepsis

SIRS + infection

Severe sepsis

Sepsis + organ dysfunction or hypotension

Septic shock

Severe sepsis + hypotension that won't come down even after fluid therapy and requires vasopressor

Common pathogens in sepsis

S. aureus, P. aeruginosa, Enterobacteriace | Gram (-) and fungi (yeast) have high mortality

What are the three things sepsis causes?

Coagulation, vasodilation, and capillary leak

Diagnosis of sepsis

do not delay abx administration due to cultures | minimum 2 blood cultures + 1 or more percutaneous blood cultures + one blood culture from each vascular access device

How do you treat hypotension in sepsis?

FLUID RESUSCITATION FIRST! If that doesn't work, then vasopressors (norepinephrine). If that doesn't work, then steroids

Disease States and Treatments Test 3 Flashcards

(68 cards)