Pharm - Cardiovascular Antibiotics Flashcards
What is the pathogen of Rheumatic Fever, what is the infection, and what age group most commonly?
Group A Strep. Upper respiratory infection (pharyngitis). 5-14 years old.
2 big clinical features of ARF?
- Heart damage in the form of valve damage (almost always mitral)
- Joint pain (knees, ankle, hips and elbows).
What is the empiric treatment for ARF and out of the two which one is really the drug of choice against ARF?
Penicillin G and gentamicin. Penicillin G.
What do we give to a patient with ARF if they have an allergy to beta lactams?
Give them a macrolide or clindamycin
What do we give for recurrent ARF in a patient allergic to beta lactams and what do we not give and why?
Give them a macrolide. We do not give clindamycin for recurrent because of the potential of causing c diff.
What can we give to manage the joint pain?
NSAIDS
What is the prototypical lesion of infective endocarditis?
Vegetation of the valve
What pathogen, that causes IE, is found in the oral cavity, skin, and upper respiratory tract?
Strep viridans. Staph. HÁČEK.
What is the empiric treatment for IE?
Vancomycin (IV) and ceftriaxone
If strep viridans is highly suspectible to penicillin G, what two drugs should we use?
Penicillin G or ceftriaxone.
What if the viridan infection is uncomplicated, the patient has no renal disease and you want a shorter drug course, what two drugs do we use for IE?
Gentamicin plus penicillin G or ceftriaxone
What if the patient has mild beta lactam sensitivity, what drug do we use for Viridan IE?
Ceftriaxone
What is preferred for patients with severe hypersentivity to beta lactam for viridan IE? What is the alternate?
The preferred drug is penicillin G desensitization. Alternate is vancomycin
How is desensitization carried out?
Give a small dose and observe and gradually increase until therapeutic dose is given. Give like a unit and wait. No reaction, increase. Once given 2 million, you can give the rest.
What two drugs to give for staph aureus IE methicillin susceptible?
Nafcillin or oxacillin
What if patient has mild beta lactam sensitivity, what do you give for staph aureus IE?
Cefazolin
What if patient has severe beta lactam hypersensitivity, what do you give for staph aureus IE?
Vancomycin or daptomycin
What do you give if there is a brain abscess accompanying the staph aureus IE?
Nafcillin
What to give for methicillin resistant IE staph aureus?
Vancomycin or daptomycin as alternate
What kind of pathogen does daptomycin take out?
Gram positive and MRSA
MOA for daptomycin?
Binds to cell membrane via calcium dependent insertion, kicks a bunch of potassium out and leads to rapid cell death.
What do we use for IE because of staph epidermidis?
Vancomycin
What do we use for HÁČEK group IE?
Ceftriaxone
What do we use for Enterococci IE?
Pen G or ampicillin or vancomycin and then add the one you choose to gentamicin
What two drugs do we use to treat pericarditis?
NSAIDS and Colchicine
What do we use in severe cases of Pericarditis?
Corticosteroids
What risk do corticosteroids lead to?
Prolong illness or relapse
What important lab to order to track/monitor treatment of pericarditis?
CRP
What is the MOA for colchicine as an anti inflammatory medicine?
Prevents tubular polymerization into microtubules which inhibits leukocyte migration and phagocytosis
What are the 5 adverse effects of colchicine and what route of administration brings on the adverse effects?
Diarrhea, hair loss, bone marrow depression, peripheral neuritis, and myopathy. IV.
