Endocarditis

Question 1

What do u need to check before choosing antibiotic therapy for endocarditis

Answer 1

Check susceptibility of antibiotic

Question 2

What is the inoculum effect?

Answer 2

High bacterial density, large colony, renders Antimicrobial activity less effective

Will see HIGH MIC indicating more resistance

Question 3

What is biofilm?

Answer 3

Biofilm is formed on prosthetic material,
Colony of bacteria accumulated and encased in a protective substance
Require longer antibiotic course

Question 4

Antibiotic selection depends on what factors?

Answer 4

Susceptibility?
Native or prosthetic valve?
Which bacteria (s aureus is most common)
Pt factors, renal function?

Question 5

What penicillin and cephalosporin is used for staph but not MRSA?

Answer 5

Oxacillin
Nafcillin

Cefazolin
Ceftriaxone

Question 6

What penicillin used for enterococcus?

Answer 6

Ampicillin

Question 7

If pt has a mild penicillin allergy and has staph infection what med can u do ?

Answer 7

Cefazolin

Question 8

Cephalosporin for staph

Answer 8

Cefazolin

Question 9

What cephalosporin used for strep

Answer 9

Ceftriaxone

Question 10

If pt has anaphylaxis reaction to penicillin can u do cephalosporin?

Answer 10

No only if mild allergy to penicillin

Question 11

Vancomycin adverse reaction ? (2) and aim for what trough concentration?

Answer 11

Nephrotoxicity
Vancomycin infusion reaction (infuse at 1g or less)
Monitor trough concentrations [15-20 mg] for s aureus

Question 12

Best way to monitor vancomycin includes

Answer 12

AUC:MIC

Question 13

AUC trough greater than 15 is associated with a risk for

Answer 13

Nephrotoxicity

Question 14

Daptomycin coverage is similar to _____, but also covers ___

Answer 14

Vancomycin

VRE

Question 15

Daptomycin cannot be used for what conditions

Answer 15

Can’t be used for meningitis or pneumonia

Doesn’t enter nervous system or lung tissue

Question 16

Daptomycin severe adverse reaction is _____

Answer 16

Rhabdomyolysis

Question 17

Gentamicin moa

Answer 17

30 s ribosome disruption of protein synthesis

Question 18

Gentamicin has synergy in combination with _____, what is gentamicin class

Answer 18

Beta lactams

Aminoglycisides

Question 19

Gentamicin adverse effects

Answer 19

Ototoxicity and nephrotoxicity , if creatine clearence is less than 30 avoid !!!

Question 20

When is rifampin used ?

Answer 20

Used for prosthetic valve enterococcus caused by staph

Question 22

Rifampin side effect

Answer 22

Side effect
(Inducer, increases hepatic metabolism of meds such as, prednisone, amiodarone) drugs become less effective if pt is on rifampin

Question 23

Linezolid adverse reaction

Answer 23

Drug, drug interactions can cause serotonin syndrome (weak MAOi properties) if used with ssris, or other foods which increase serotonin

Question 24

Long duration Aminoglycosides (gentamicin) can cause what

Answer 24

Clostridium difficile, infection which may occur, 4 weeks AFTER last dose of antibiotic

Question 25

Prosthetic valve for endocarditis what med could be used

Answer 25

Rifampin or gentamicin

Question 26

Which bacteria requires a combination of medications because it is harder to treat?

Answer 26

Enterococcus

Question 27

Combination meds for enterococcus

Answer 27

Ampicillin and gentamicin Ampicillin and ceftriaxone

Question 28

Ceftriaxone alone has ___ activity against enterococcus species

Answer 28

NO

Question 29

If patient had a creatinine. Clearance less than 30 (poor renal function) and has blood cultures come back positive for enterococcus, what would us use to treat this patient?

Answer 29

Combo med, ampicillin and ceftriaxone Dosed 2 g every 12 hours Do not want to do ampicillin and gentamicin if patient had renal dysfunction

Question 30

If pt is resistant to gentamicin what can u do for meds instead ?For enterococcus

Answer 30

Can do ampicillin and ceftriaxone

Question 31

If pt resistant to ampicillin and gentamicin and ampicillin ceftriaxone what can u do? If penicillin resistant or can’t take any beta lactam for enterococcus

Answer 31

Can do vanco and gentamicin

Question 32

Last resort, what two meds can u give for enterococcus?

Answer 32

Daptomycin or Linezolid

Question 33

Dental prophylaxis to prevent endocarditis in patients at risk involves which meds

Answer 33

Single dose amoxicillin

Question 34

Dental prophylaxis, amoxicillin, cannot be given due to penicillin allergy which medication would be given next?

Answer 34

Would give Clarithromycin or Azithromycin or a high dose cephalexin

Question 35

Treatment for MSSA for staphylococcus natives valve?

Answer 35

Oxacillin, Nafcillin, or cefazolin

Question 36

Treatment for MRSA

Answer 36

Vancomycin can do daptomycin (6 weeks)

Question 37

What group of bacteria commonly occurs in mouth and respiratory tract

Answer 37

Viridans group streptococci

Question 38

A pt with a history of iv drug use presents with fever, and new murmur, ur culture sample identifies staphylococcus aureus, what is ur treatment plan if patient has a penicillin anaphylaxis reaction Native valve

Answer 38

Vancomycin

Question 39

Pt comes in with new fever, malaise, and u see Roth spots, Jane way lesion, u suspect endocarditis, and pt is an iv drug user. And have native valve what to start

Answer 39

Suspect staph aureus, and want to use Nafcillin or oxacillin, if patient cannot tolerate penicillin will do cefazolin

Question 40

If pt has iv drug abuse history and native valve and u note fever, Jane way lesions, and u also see on echo, pt cannot tolerate oxacillin or Nafcillin what would u give?

Answer 40

Cefazolin

Question 41

Relatively resistant [ on report] viridans strep or strep gallolyctic treatment in native valves

Answer 41

Penicillin g or ceftriaxone 4 weeks plus gentamicin 2 weeks

Question 42

Susceptible viridans grouo strep or streptococcus galloycticus tx ? Native valve

Answer 42

Penicillin G or ceftriaxone or vancomycin Alternate, penicillin g or ceftriaxone. Plus gentamicin. 2 week total

Question 43

MRSA treatment with native valve is how long

Answer 43

6 weeks. Vanco or daptomycin

Question 44

Pt with prosthetic valve and culture is positive for MSSA what would treatment consist of

Answer 44

Nafcillin, or oxacillin, or cefazolin Plus rifampin Plus Gentamicin (2 weeks)

Question 45

Pt with prosthetic valve and culture is positive for MRSA what would treatment consist of?

Answer 45

Vancomycin Rifampin and Gentamicin (2 weeks) 6 weeks total

Question 47

Native valve staph [MSSA] treatment

Answer 47

Nafcillin, oxacillin or cefazolin, 6 weeks

Question 48

Highly suspeptible viridans strep, native valve treatment ? How long and what meds?

Answer 48

Penicillin g or ceftraxone Or vanco 4 weeks

Question 49

Resistant viridans broup strep, strep gallocytlictus native valve

Answer 49

Penicillin g or ceftriaxone (4 weeks) Gentamicin *2 weeks

Question 50

Time dependent killer for endocarditis, what antibiotics,

Answer 50

Beta lactams

Question 51

What are concentration dependent killers, antibiotics ?

Answer 51

Aminoglycisides, fluoroquinolone Higher concentration there is greater killing Target peak concentration = 10x the MIC

Question 52

For vancomycin, draw first levels (check trough) before the ___ dose, an exception which would require more frequent monitoring would be if patient has changing _____ function

Answer 52

4th Renal

Question 53

Vancomycin dosing is based on ____

Answer 53

Body weight

Question 54

Alternate regimen for viridans strep or strep gallocyticus, native valve [susceptible]

Answer 54

Penicillin g or ceftriaxone PLUS gentamicin 2 week

Question 55

Common empiric regimen before knowing which organism and the MIC is what

Answer 55

Ceftriaxone and vancomycin

Question 56

A pt presents with ototoxicity what med could they previously been taking

Answer 56

Vancomycin or gentamicin

Question 57

Gentamicin monitoring peak range is from ______, and trough is ___

Answer 57

3-4 mg <1