Pharmacology

Question 1

What antibacterial agents should be used in the treatment of infectious endocarditis?

Answer 1

Prolonged course of BACTERIOCIDAL antibiotics based on culture and sensitivity.
The optimal tx depends on the result of culture and the MIC of the anitbiotics. While culture results are pending broad spectrum cover is recommend: β lactams and possibly aminoglycosides (with concurrent IVFT and NO concurrent furosemide tx due to concern re: nephrotoxicity). 1-2 weeks of iv therapy followed by oral treatment for 6-8 weeks + is recommended. The treatment of choice for bartonella is not weel defined. Gentamycin was effective in one in vitro study. In people aminoglycosides for 2 weeks has been shown to improve survival. In dogs with systemic bartonellosis doxycycline, azithromycin, enrofloxacin and pot amoxicillin have resulted in good clinical recovery.

Question 2

Should anticoagulant therapy be used in patients with infectious endocarditis?

Answer 2

Anticoagulant or antiplatelet activity is not currently recommended unless patietns have a documented hypercoagulable state (e.g. with concurrent PLN or DIC).

Question 3

When should repet cultures post treatment of infectious endocarditis be performed?

Answer 3

-2 weeks post starting ab therapy and 2 weeks after terminating ab therapy.

Question 4

What is the active formula of entresto

Answer 4

sacubitril/valsartan

Question 5

what drug clases does entresto belong to?

Answer 5

angiotensin receptor-neprilysin inhibitor (ARNi); neprilysin inhibitor and angiotensin II receptor blocker (ARB)

Question 6

How do the active ingredients of entresto work?

Answer 6

1. Sacubitril:
   Mechanism:
   Sacubitril is a neprilysin inhibitor. Neprilysin is an enzyme that breaks down natriuretic peptides, which are beneficial molecules in the body that help regulate blood pressure, reduce fluid retention, and decrease strain on the heart. By inhibiting neprilysin, sacubitril allows these natriuretic peptides to remain active for longer.
   Effect:
   This leads to:
   Dilation (widening) of blood vessels.
   Reduced blood pressure.
   Reduced sodium and water retention.
   Decreased workload on the heart.
2. Valsartan:
   Mechanism:
   Valsartan is an angiotensin II receptor blocker (ARB). Angiotensin II is a hormone that causes blood vessels to constrict, leading to increased blood pressure and forcing the heart to work harder. Valsartan blocks the action of angiotensin II by preventing it from binding to its receptors on blood vessels.

Effect:
By blocking angiotensin II, valsartan:
Lowers blood pressure.
Reduces strain on the heart.
Decreases the risk of heart failure worsening by preventing harmful remodeling of the heart.

Question 7

How is NT-proBNP produced

Answer 7

1) Heart wall stretching releases precursor proBNP from the heart’s atria and ventricles.
2) Cleavage: ProBNP is split into two fragments:
BNP: the active hormone, which has a direct role in reducing stress on the heart.
NT-proBNP: an inactive fragment, but its level correlates with the level of BNP, thus serving as a useful marker of heart failure severity.

Question 8

What is the role of BNP ?

Answer 8

1) Vasodilation: BNP causes the blood vessels to dilate, which reduces afterload and preload

2)Diuresis and Natriuresis: Diuresis: BNP promotes the elimination of water through increased urine production by the kidneys.
Natriuresis: It also enhances the excretion of sodium (salt) in the urine.

3) Inhibition of the Renin-Angiotensin-Aldosterone System (RAAS):

4) Inhibition of Sympathetic Nervous System Activity:

Question 9

How does BNP affect the RAAS

Answer 9

It downregulates the release of renin