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PHRM 865: Theraputics V > Lecture 19.1: Endocarditis > Flashcards

Lecture 19.1: Endocarditis Flashcards

1
Q

What is the way that blood flows within the heart?

A
  • Pulmonary –> R. Atrium through Tricuspid –> R. Ventricle through Pulmonary to Lungs
  • Lungs –> L> Atruim through Mitral –> L. Ventricle through Arotic to Pulmonary
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2
Q

What are some of the risk factors for someone with Infective Endocarditis?

A
  • Has Prosthetic Valve [HIGHEST RISK]
  • Previous Endocarditis [HIGHEST RISK]
  • IV drug use
  • Heart Disease
  • Cardiac Implantables
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3
Q

What are the pathogens that are assoicated with Infective Endocarditis?

A
  • S. Aureus [30-70%; MOST COMMON]
  • Virdian Strep [10-30%; Sanguies, Mitis, Salivarius, Uberis, Mutans, Mitior]
  • Entercocci [5-18%; Faecalis, Faecium]
  • HEACK Group [dont need to know]

HACEK: Haemophilus Parainfluenzae, Aggregatibacter Actinomycetemcomitans, Cardiobacterium Hominis, Eikenella Corrodens, Kingella Kingae

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4
Q

What is the pahthophysiology of Endocarditis?

A
  • Trauma or Bacterial Adherence [basically damaging the valves or having things stick to them]

Inoculum Effect

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5
Q

What are the clinical Presentations for endocarditis?

A
  • Fever, malaise, fatigue, Heart Murmur, weakness, Dyspnea [right side], night sweats, weight loss
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6
Q

What is the single most important Laboratoroy finding for Endocarditis?

A
  • Blood Cultures

Others: Hematologic, Increased ESR & CRP, Urinalysis

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7
Q

What are the peripheral Manifestations for Endocarditis?

A
  • Osler’s Nodes: Pads on fingers and toes hurt
  • Janeways Lesions: Palms of hands or feet hurt
  • Splinter Hemorrhages: under nail bed
  • Petechiae
  • Roth Spots: retinal Lesions
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8
Q

What is the big diagnosis criteria for endocarditis?

A
  • 2023 Duke-International Society for CV Infectious Disease
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9
Q

What are some of the general treatment considerations for endocarditis?

A
  • Eradicate infection [may take weeks to do
  • HIGH doses
  • Bactericidal is required
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10
Q

For Viridans Group Strep, what is the Treatment for Native Valve Endocarditis & Highly Pen-susceptible?

MIC < 0.12

A
  • Pen G 12-18million units OR Ceftriaxone 2g [4w]
  • Pen G + Gent [2w]
  • Caftriaxone + Gent [2w]
  • Vancomycin [b-lactam allergy] [4w]

MIC < 0.12

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11
Q

For Viridans Group Strep, what is the Treatment for Native Valve Endocarditis & Pen “Relatively” Resistant?

MIC > 0.12 to < 0.5

A
  • Pen G 24 million + Gent [4w:2w]
  • Ceftriaxone 2g + Gent [4w:2w]
  • Vancomycin [b-lactam allergy] [4w]

MIC > 0.12 to < 0.5

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12
Q

For Viridans Group Strep, what is the Treatment for Prosthetic Valve Endocarditis & Pencillin Suseptible?

MIC < 0.12

A
  • Pen G 24 million +/- Gent [6w:2w]
  • Ceftriaxone 2 g +/- Gent [6w:2w]
  • Vancomycin [b-lactam allergy] [6w]
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13
Q

For Viridans Group Strep, what is the Treatment for Prosthetic Valve Endocarditis & Pencillin Relatively or Full Resistant?

MIC > 0.12

A
  • Pen G 24 million + Gent [6w]
  • Ceftriaxone + Gent [6w]
  • Vancomycin [if b-lactam allergy] [6w]
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14
Q

For Staphylococci, what is the Treatment for Native Valve Endocarditis?

A
  • Nafcillin or Cefaozlin [MSSA] [6w]
  • Vancomycin or Daptomycin [MRSA] [6w]

Dapto for right sided

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15
Q

What are some of the possible MRSA alternatives for endocarditis?

A
  • Ceftaroline [+ Dapto]
  • Linezolid [Maybe Tedizolid]
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16
Q

For Staphylococci, what is the Treatment for Prosthetic Valve Endocarditis?

MSSA? MRSA?

A
  • Nafcillin + Rifampin + Gent [MSSA] [6w:6w:2w]
  • Vancomycin + Rifampin + Gent [MRSA] [6w:6w:2w]

Rifampin is able to get into the bioflim

17
Q

For Enterococci, what is the Treatment for Native or Prosthetic Valve Endocarditis & Penicillin- and Gentamicin-suseptible?

A
  • Amp + Gent [4-6w]
  • Pen 18-30million + Gent [4-6w]
  • Amp + Ceftriaxone [6w]
18
Q

For Enterococci, what is the Treatment for Prosthetic Valve Endocarditis & Penicillin-Susceptible & Aminoglycoside-Resistant Strains?

A
  • Amp + Ceftriazone

Good for Faecailis

19
Q

For Enterococci, what is the Treatment for Prosthetic Valve Endocarditis & Unable to tolerate B-lactam Therapy?

A
  • Vancomycin + Gent [6w]
20
Q

For Enterococci, what is the Treatment for Prosthetic Valve Endocarditis & Vancomycin-Resistant Strains?

A
  • Daptomycin

PHRM 865: Theraputics V (42 decks)

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