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Pathophysiology Exam 3 > Endocarditis 1 > Flashcards

Endocarditis 1 Flashcards

1
Q

_________ refers to infection of the heart valves by various microorganisms

A

Endocarditis

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2
Q

The following are signs/symptoms of what?

  • Sxs
    • Fever, chills, weakness, dyspnea, night sweats, weight loss, and/or malaise
  • Signs
    • fever
    • heart murmur
    • embolic phenomenon
    • splenomegaly
    • Osler’s nodes (painful), Janeway’s lesions
A

Infective Endocarditis

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3
Q

What is the name of the criteria used to dx endocarditis?

A

Duke Criteria

(major= blood culture + for infective endocarditis, evidence of endocardial involvement

minor= risk factors, fever, conjunctival hemorrhages, janeways lesions, etc)

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4
Q

What 3 groups of organisms cause a majority of infective endocarditis cases?

A

Streptococci (9-38%)

Staphylococci (30-70%)

Enterococci

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5
Q

Which specific staphylococci is the MC

A

Staph aureus

(coagulase positive)

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6
Q

What is the tx approach for infective endocarditis (IE)?

A
  1. isolate pathogen (blood culture from 2 dif sites)
  2. Determine antimicrobial susceptibilities
  3. High dose IV bactericidal abx for extended period

4. Surgery (valvectomy/valve replacement)- important adjunct in tx of NVE and PVE

(NVE= native valve, PVE= prosthetic valve)

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7
Q

Why has Staphylococcal endocarditis become more prevalent?

A

b/c of increased IVDA

(also from more frequent use of peripheral/central venous catheters)

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8
Q

What is the most common organism causing infective endocarditis among those with IVDA and persons with venous catheters

A

S. aureus

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9
Q

What coagulase-negative staphylococci are prominent causes of PVE?

A

usually Staphylococcus epidermidis

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10
Q

What valve is most frequently infected in a IVDA patient?

A

Tricuspid valve (right sided IE)

–> caused by S. aureus

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11
Q

How do you tx an IVDA pt w/ staphylococcus endocarditis?

A

2 week course of:

Nafcillin or oxacillin + Aminoglycoside

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12
Q

What is an especially common cause of endocarditis involving native valves? Is this generally acute or subacute?

A

Strep viridans (common inhabitants of mouth/gingiva)

subacute

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13
Q

________ are normal inhabitants of the human GI tract and, occasionally, of the anterior urethra

A

Enterococci

(the cause of enterococcal endocarditis)

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14
Q

How do you tx infective endocarditis caused by the HACEK group of organisms?

(HACEK= H. flu, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae)

A

High-dose ampicillin + gentamicin x4 weeks

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15
Q
  • What native valve does the HACEK group most commonly infect?
  • Is this considered community or hospital acquired IE?
  • Subacute or acute?
A
  • Native Valve
  • Community-acquired
  • Subacute (w/ lg vegetations and emboli)
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16
Q

What is the group of drugs that remain the drug of choice for endocarditis?

A

β-Lactam antibiotics

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17
Q

Which β-Lactam antibiotic is the drug of choice for IE caused by strep?

A

Penicillin G (or ceftriaxone)

(this is not the only med used to tx this, just the specific B-lactam)

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18
Q

Which β-Lactam antibiotic is the drug of choice for IE caused by staph?

A

Nafcillin

(this is not the only med used to tx this, just the specific B-lactam)

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19
Q

Which β-Lactam antibiotic is the drug of choice for IE caused by enterococci?

A

Ampicillin

(this is not the only med used to tx this, just the specific B-lactam)

20
Q

Which group of microbes causes large vegetations and emboli?

A

HACEK group

  • Haemophilus parainfluenzae, Haemophilus aphrophilus,
  • Actinobacillus actinomycetemcomitans,
  • Cardiobacterium hominis,
  • Eikenella corrodens,
  • Kingella kingae
21
Q

Empiric therapy for IE should cover what 3 groups of bacteria?

A
  • Staphylococci (methicillin-susceptible and resistant)
  • streptococci
  • enterococci
22
Q

What is empiric drug therapy for Native Valve infective endocarditis?

A

Vancomycin + Ceftriaxone

23
Q

What is empiric drug therapy for Prosthetic Valve infective endocarditis?

A

Vancomycin + Gentamicin + Rifampin

24
Q

Example test question:

Someone has prosthtic valve Endocarditis caused by strep viridans and is allergic to PCN- what are you going to order and for how long? (it is sensitive to penicillin)

(she said to not memorize the chart but then said this was a sample test question so IDK)

A

Vancomycin x6 weeks

25
Q

What are the 2 major adverse drug rxns of Daptomycin and what are the monitoring parameters?

A

ADEs:

  1. Myopathy- monitor creatinine phosphokinase weekly
  2. Rhabdomyolysis- monitor for signs/sxs of mm. pain
26
Q

What are the 3 major ADEs of Gentamicin?

A

ADEs:

  1. Nephrotoxicity
  2. Ototoxicity
  3. neuromuscular blockade
27
Q

What are the 3 major ADEs of linezolid and how do you monitor?

A

ADEs:

  1. Thrombocytopenia
  2. optic neuropathy
  3. peripheral neuropathy

Monitoring:

  1. platelet counts at baseline and weekly
  2. visual changes
28
Q

WHat is the 1 major ADE of Rifampin and how do you monitor?

A

Hepatotoxicity

monitor baseline liver function tests, and then at least every 2-4 wks during therapy

29
Q

What are the 2 major ADEs of Vancomycin?

A
  1. Nephrotoxicity
  2. Red Man Syndrome
30
Q

Daptomycin- when is more frequent monitoring warrented?

A

In patients w/ renal dysfunction or receiving concomitant therapy w/ HMG-CoA reductase inhibitors (statins)

31
Q

When should Daptomycin be discontinued?

A

If symptomatic and CPK >5x upper limit of normal (ULN) or if CPK > 10x ULN

32
Q

If taking Gentamicin, you should avoid concomitant use of what?

A
  • of other nephrotoxic agents such as diuretics, nonsteroidal anti-inflammatory drugs, and radiocontrast media
33
Q

T/F: you should avoid rapid IV administration of Gentamicin?

A

True

34
Q

ADEs of Linezolid:

Thrombocytopenia is MC in >___ weeks of prolonged therapy

A

>2 weeks

35
Q

ADEs of Linezolid:

Visual symptoms are MC after >___ days of prolonged therapy

A

28

36
Q

Which medication might cause red or orange discoloration of bodily secretions (urine, sweat, tears)?

A

Rifampin

37
Q

ADE of Vancomycin:

How is red man syndrome managed?

A

Red man syndrome may be managed by prolonging the infusion time from 1-2 hours

Administration of antihistimine prior to loading or maintenacne doses also be considered

38
Q

Although there is controversy over antimicrobial prophylaxis of infective endocarditis (what to give and when), everyone agrees on what makes a patient “high risk”.

What makes a person high risk?

A
  1. Presence of prosthetic heart valve
  2. prior dx of infective endocarditis
  3. cardiac transplantation w/ subsequent valulopathy
  4. congenital heart disease
39
Q

For patients w/ high risk underlying cardiac conditions, What types of procedures should be given antimicrobial prophylaxis for infective endocarditis?

A

any that require perforation of the oral mucosa or manipulation of the periapical region of the teeth of gingival tissue

40
Q

What is the MC drug prescribed for prophylaxis of infective endocarditis?

Which drug do dentists really like to give for prophylaxis?

A

MC- Oral amoxicillin

Dentists- oral Clindamycin

41
Q

Infective endocarditis prophylaxis for dental procedures should be recommended only for patients with what?

A

underlying cardiac conditions associated with the highest risk

42
Q

Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergoe which 2 types of procedures?

A

genitourinary or GI tract procedure

43
Q

According to UpToDate, when is prophylaxis not recommended?

A
  1. Common valvular lesions for which antimicrobial prophylaxis is NOT recommended include:
    1. bicuspid aortic valve
    2. acquired aortic or mitral valve disease (including mitral valve prolapse with regurgitation)
    3. hypertrophic cardiomyopathy with latent or resting obstruction
44
Q

T/F: the following are examples of dental procedures where IE prophylaxis is recommended:

Tooth extractions, drainage of dental abscess, routine dental cleaning

A

True

45
Q

Clinical Pearl:

Initiation of ________ for tx of native valve infective S. aureus is optional.Why?

Routine use of _________ for tx of native valve endocarditis should be avoided

A

gentamicin

recent literature reports increased risk of nephrotoxicity when combining gentamicin w/ vanco or antistaphylococcal agents in comparison to daptomycin monotherapy

Pathophysiology Exam 3 (12 decks)

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