endocarditis therapeutics Flashcards Preview

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Flashcards in endocarditis therapeutics Deck (26)
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1

pathophysiology of endocarditis

-previously damaged heart valve
-platelet-fibrin deposition creating thrombosis
-bacteremia
-bacterial adherence to thrombus

2

procedures associated with bacteremia

-dental extraction
-tonsillectomy
-cystoscopy
-tooth brushing/flossing

3

most common bacteria in endocarditis

staph
strep

4

clinical presentations of endocarditis

-fever
-cough
-dyspnea
-anorexia
-weight loss
-night sweats
-fatigue
-splenomegaly
-back pain

5

less common presentations of endocarditis

-clubbing fingertips
-splinter hemorrhages
-retinal eye lesions

6

uncommon presentations of endocarditis

-osler's nodes (painful)
-janeway lesions (nontender)

7

symptoms of right heart failure

-nausea, abdominal pain
-peripheral edema
-hepatojugular reflux
-JVD
-hepatomegaly
-anorexia
-constipation

8

symptoms of left heart failure

-dyspnea
-nocturnal dyspnea
-othopnea
-tachypnea
-hemoptysis
-pulmonary edema
-S3 gallop

9

endocardiditis workup plan

-identify Sx including CHF
-3 consecutive blood cultures for >90% (draw 1st & 3rd at least 1 hours apart)
-venopuncture 1 culture = 2 bottles (aerobe and anaerobe)
-echocardiogram
-chest x-ray

10

antibiotics for native valve S.viridans

PCN
ceftriazone
vancomycin

11

antibiotics for enterococcus in endocarditis

-linezolid
-daptomycin
for over 6 weeks

12

antibiotics for native valve MSSA

nafcillin
cefazolin

13

antibiotics for native valve MRSA

vancomycin
daptomycin

14

empiric antibiotics for prosthetic valve when IE develops <2 months after placed

vanco +
-gent
-rifampin

15

empiric antibiotics for prosthetic valve when IE develops >2 after placed

vanco +
-gent
-rifampin

16

antibiotics for prosthetic valve w/ PCN susceptible if MIC < 0.12 viridans strep and S.gallolyticus

-PCN g x6wk
-ceftriaxone x6wk
-ampicillin x6wk
+/- gentamycin x2wk
-vancomycin x6wk

17

antibiotics for prosthetic valve w/ PCN resistance or MIC >0.12 in viridans strep and S.gallolyticus

-PCN G +gent
-ceftriaxone +gent
-vancomycin

18

antibiotics for prosthetic valve MSSA infection

nafcillin +
-rifampin TID
-gentamicin

19

antibiotics for prosthetic valve MRSA infection

-vanco+rifampin+gent
-vanco
-rifampin
-gent

20

HACEK IE features

-slow growers over 2-3 weeks (cultures needs lots of time)
-large friable vegetaitons

21

antibiotics for HACEK in native or prosthetic valves

ceftriaxone first
-native = 4 weeks
-prosthetic = 6 weeks
*other options after C&S amp/sulbac or cipro

22

complication of IE

CHF

23

prophylaxis of IE is recommended for

-patients with prior outlined condition
AND
-who undergo procedures likely to enhance bacteremia

24

conditions that prophylaxis are recommended for

-prosthetic valves or valve repair
-prior IE
-congenital heart disease
-heart transplant w/ regurgitation

25

procedures that prophylaxis is recommended for

-dental procedures involving gingival tissue
-periapical region of teeth
-perforation of oral mucosa

26

antibiotics for dental prophylaxis

-amoxicillin 2g
-ampicillin 2g
-clindamycin 600 mg
-azithromycin 500 mg
-clarithromycin 500 mg
-cephalexin 2g
-clindamycin 600 mg
-cefazolin 1g