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Therapeutics Exam 2 > Endocarditis > Flashcards

Endocarditis Flashcards

0
Q

Describe pathophysiology of endocarditis

A

Infxn results from colonization of damaged valvular endothelium by circulating bacteria with specific adherence properties

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1
Q

Endocarditis is more likely in…

A

2x more likely in Men

Age > 50

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2
Q

Endothelial damage may result from…

A
  • jet-lesions due to turbulent blood flow
  • electrodes
  • catheters
  • repeated IV injections of solid particles in IVDA
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3
Q

Which side of heart is more likely in IVDA?

A

Right

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4
Q

Which side of heart is more likely in Community-associated and healthcare acquired?

A

Left

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5
Q

Which side of heart is more likely to have a high mortality rate?

A

Left

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6
Q

Which side of heart is frequently associated with embolic stroke?

A

Left

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7
Q

Which side of heart is surgical benefits greatest in early phase of IE?

A

Left

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8
Q

Which side of heart involves the aortic and mitral(bicuspid) valves?

A

Left

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9
Q

Which side of heart involves the tricuspid valve?

A

Right

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10
Q

Which side of heart is septic pulmonary embolism more common?

A

Right

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11
Q

Which valve is rarely involved in IE?

A

Pulmonary Valve

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12
Q

Which side of heart has higher IE cure rates (>85%)?

A

Right

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13
Q

Which side of heart is IE surgery rarely indicated?

A

Right

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14
Q

RFs of IE…

A 
Prosthetic Valve/Implant
Previous IE
Congenital Heart Dz
Chronic IV
Diabetes
Healthcare related exposure
Acquired valvular dysfunction 
CHF
Mitral valve prolapse with regurgitation
IV drug abuse
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15
Q

Most common pathogens in IE…

A

Staph
Strep
Enterococcus

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16
Q

What is the most common pathogen in IVDA?

A

S. aureus

17
Q

S. Aureus is coagulase ___ .

A

Positive

18
Q

Coagulase ___ ______ is more common in prosthetic valve endocarditis.

A

Negative staph

also staph. aureus (coagulase positive)

19
Q

Most common IE pathogen for IVDA’s?

A

Staph. aureus

20
Q

Major criteria for diagnosis of IE?

A 
Positive culture (staph, strep, enterococcus or HACEK)
TTE/TEE
21
Q

Diagnosis of Definite IE

A

2 major
1 major + 3 minor
5 minor

22
Q

Diagnosis of Possible IE

A

1 major + 1 minor

3 minor

23
Q

Tx of NATIVE valve, PCN-S strep

A

Pen G or Ceftriaxone x 4 weeks
or
Pen G or Ceftriaxone PLUS Gent x 2 weeks

If PCN allergy, use Vanc x 4 weeks

24
Q

Tx of NATIVE valve, PCN-I/R strep

A

Vanc x 4 weeks

Pen G or Ceftriaxone x4 wks PLUS Gent x2wks

25
Q

Tx of PROSTHETIC valve, PCN-S strep

A

Pen G or Ceftriaxone x6 wks +/- Gent x2 wks

Vanc x6 wks if PCN allergy

26
Q

Tx of PROSTHETIC valve, PCN-I/R strep

A

Vanc x6 wks

Pen G or Ceftriaxone PLUS Gent x6 wks

27
Q

Tx of NATIVE valve, MSSA

A

Nafcillin or oxacillin x 6 weeks

+/- Gent x3-5 days

28
Q

Tx of NATIVE valve, MSSA (w/PCN allergy)

A

Cefazolin x6 weeks (minor allergy)

If Anaphylaxis to PCN, use Vanc. x6 wks

29
Q

Tx of NATIVE valve, MRSA

A

Vanc x6 weeks

30
Q

Tx of PROSTHETIC valve, MSSA

A

Nafcillin or oxacillin >6 weeks
PLUS Rifampin >6 weeks
PLUS Gentamicin x2 weeks

31
Q

Tx of PROSTHETIC valve, MRSA

A

Vanc >6 weeks
PLUS Rifampin >6 weeks
PLUS Gentamicin x2 weeks

32
Q

When do you need to use Vanc + Gent in strep?

A

Never

33
Q

When do you need to use Vanc + Gent in staph?

A

Only with PROSTHETIC valve MRSA

34
Q

Tx of NATIVE or PROSTHETIC valve, ENTEROCOCCUS (PCN, Gent, and Vanc - S)

A 
Amp or Pen G x4-6 weeks
PLUS Gent (makes it cidal) x4-6 weeks

Native <3months = 4 weeks,
All others x6 weeks

35
Q

Tx of NATIVE or PROSTHETIC valve, ENTEROCOCCUS (PCN, Streptomycin, and Vanc - S) and (Gent -R)

A

Ampicillin or Pen G
PLUS Streptomycin x4-6 weeks

(Use Vanc if PCN allergy)

36
Q

Tx of NATIVE or PROSTHETIC valve, ENTEROCOCCUS (PCN - R) and (Vanc, Aminoglycoside - S)

A

Vanc PLUS Gent x6 weeks

37
Q

Tx of NATIVE or PROSTHETIC valve, ENTEROCOCCUS (PCN, Aminoglycoside, and Vanc - R) positive for Enterococcus faecium

A

Linezolid >8 weeks (monitor plts) or

Quinupristin-Dalfopristin >8 weeks

38
Q

Tx of NATIVE or PROSTHETIC valve, ENTEROCOCCUS (PCN, Aminoglycoside, and Vanc - R) positive for Enterococcus faecalis

A

Ceftriaxone PLUS Ampicillin > 8 weeks
or
Imipenem/cilastatin PLUS Ampicillin > 8 wks (seizures)

Both make use of double beta-lactam therapy

39
Q

How to measure DUR in IE pts and other monitoring

A

Set length of tx from 1st day of negative blood culture
Monitor renal fx w/Aminoglycosides >1 wk
Monitor Vanc/Gent trough concentrations

40
Q

DUR for all staph IE

A

6 weeks (plus 2 weeks for Gent in prosthetic)

41
Q

When do you use Rifampin in IE?

A

Tx of PROSTHETIC IE - MSSA and MRSA

Therapeutics Exam 2 (15 decks)

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