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Pharmacy 255 > Endocarditis > Flashcards

Endocarditis Flashcards

1
Q

What is endocarditis?

A

infection of heart valves and other heart tissue

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2
Q

Who often gets endocarditis?

A

> 50 and PWID

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3
Q

Explain briefly the pathophysiology of endocarditis?

A

trauma of heart= place to colonize OR thrombus- thrombus protects

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4
Q

What is considered acute endocarditis?

A

normal valves, often staph aureus, severe and rapid

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5
Q

What is considered subacute endocarditis

A

months, valve disease, hx of dental work, strep or entero

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6
Q

What is the time frame of prosthetic valve endocarditis?

A

in 1 year, usually stapoh

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7
Q

Risk factors for endocarditis?

A

male,>50, PWID, Heart disease, DM, bad oral hygiene

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8
Q

Which people generally get staph aureus endocarditis?

A

PWID

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9
Q

Which people get strep endocarditis?

A

from dental or resp surgery

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10
Q

Which people get enterocci endocarditis?

A

Gi surgery

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11
Q

Sx of endocarditis?

A

fever, heart murmer, fatigue, weight loss, osler nodes, janeway lesions, splinter hemorrhages, petechiae embolism

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12
Q

What is osler nodes?

A

purple painful nodes

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13
Q

What are janeway lesions?

A

red painless lesions on hands and feeet

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14
Q

What are splinter hemorrhages?

A

bleeding under nails

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15
Q

What are petechiae?

A

painless bleeding in eye bed

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16
Q

Which type of endocarditis (left or right) does IV drug use cause?

A

right= presents with lung sx

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17
Q

What do labs show for endocarditis?

A

increased WBC, NORMAL ANEMIA, ESRP, RF

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18
Q

How do you perform a proper blood sample?

A

from 3 different sites

19
Q

For diagnosis, how many major and minor factors are definite endocarditis?

A

2 major or 1 major and 3 minor or 5 minor

20
Q

What can happen if endocarditis is not treated?

A

destruction of valve, HF, stroke

21
Q

Why are bacteria hard to kill in endocarditis?

A

vegetation protect
in dense area so b lactamase high amounts

22
Q

How long is typical therapy for endocarditis?

A

4-6 weeks

23
Q

What is empiric therapy for endocarditis?

A

Pen G/ amp and AMG

24
Q

What clues indicate staph aureus?

A

Iv Drug user, skin disorder, burns, AIDS, DM

25
Q

What is treatment for strep?

A

Pen g or ceftriaxone for 4 weeks if normal valves, 6 weeks for prosthetic valves

26
Q

If a person cannot tolerate 1st line treat for strep what is the next step?

A

vanco for 4 weeks

27
Q

What can we add to strep treatment to make it 2 weeks?

A

gentamicin

28
Q

If strep is resistant to penicillin what can we do?

A

switch to vanco or add gentamicin

29
Q

When is penicillin resistance high? and relatively high?

A

High=>0.5
relative= 0.2-0.5

30
Q

For staph what is treatment?

A

not MRSA= cefazolin for 6 weeks
MRSA= Vanco for 6 weeks

31
Q

If staph and prosthetic valves what is treatment and what must we do?

A

Add AMG and rifampin=RENAL TOX

32
Q

For enterococci treatment what is it?

A

4-6 weeks of pen/amp +AMG= NEEDED because synergistic

33
Q

If pen resistant/ allergy for entero what is treatment?

A

vanco

34
Q

What must we do after 10 days of therapy for endocarditis?

A

switch to oral for left sided

35
Q

Since endocarditis can occur if you have prosthetic valves and you are on anticoag, what should you do?

A

d/c if CNS embolic event for 2 weeks

36
Q

What monitoring is needed during therapy?

A

culture q24 hours, s/e, serum [], sx, worsening heart murmur, HF

37
Q

What is best way to prevent endocarditis?

A

dental hygiene

38
Q

What factors indicate prophylaxis for dental procedure?

A

prosthetic valves, prior IE, CHD, heart transplant,

39
Q

What is regimine for dental prophylactic treatment?

A

amoxicillin 2 g 30-60 minutes before
if allergic= cephalexin 2 g
if cant take oral= amp/cefazolin

40
Q

If a patient forgets to tak a/b before dental procedure what do you say?

A

can take it up to 2 hrs after

41
Q

What is treat for resp surgery prophylaxis?

A

same as dental

42
Q

What is treat for gi surgery prophylaxis?

A

NOTHING

43
Q
A

Pharmacy 255 (16 decks)

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