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21-Endocarditis
endo
67
Chemistry
Graduate
04/01/2019

Additional Chemistry Flashcards

 


 

Cards

Term
Inc sed rate and inc CRP indicate>>>
Definition
Non specific inflammation somewher in body
Term
Infective endocarditis (IE)
Definition
inflamed inner lining of hrt chambers/valves w/ infxn etiology
Term
right sided IE
Definition
tricuspid valve
Term
left sided IE
Definition
aortic or mitral valve
Term
Classifications of IE
Definition
-Lesion location:left/right sided
-Native valve: valve you were born with
-Prosthetic valve: surgically placed
-Healthcare,community, Intravenous drug use
-Device related:pacemaker
Term
Which Valve is most cases
Definition
70% Native valve (NVE)
Term
PVE mostly in>>>
Definition
Developed countries
Term
Highest mortality in Endocarditis
Definition
Healthcare associated endocarditis (40%)
Term
Valve most affected in IV drug users
Definition
Tricuspid valve (right sided)
Term
NBTE
Definition
Non bacterial thrombotic endocarditis
-restricts normal blood flow. bacteria settle in low pressure area
Term
Hallmark of IE
Definition
Vegetation: platelt fibrin complex. bacteria settle and are impervious to immune response
Term
vegetation not seen in ______ of pts
Definition
25% of ECGs
Term
Organism most causing endocarditis
Definition
Staphylococcus aureus
Term
IE Organisms (majority)
Definition
Staph. Aureus, Viridans strep, strep bovis,enterococci
Term
SXs
Definition
FEVER, HEART MURMER (new, or worsened)
-chills
-Arterial emboli
-embolic/immune complexes
-myalgia
Term
Complications of IE
Definition
-Musculoskeletal: pain myalgia
Resp:Dyspnea, tachycardia
Embolic: chest CT showing pulmonary Septic emboli
Term
Suspect IE
Definition
unexplained persistently + blood culture
-blood culture + 72 hrs after catheter removed
-embolism/sepsis of unknown origin
Term
Major criteria IE
Definition
-2 separate cultures of orgs known to cause IE
-at least 2 cultures >12 hrs apart
-all3 or majority >/= 4 sep cultures drawn w/ in 1 hr
-single pos cult of >1:8000 for coxiella burnettii
Term
Major Criteria:Evidence of endocardial involved
Definition
+ echo for IE
New valvular regurg
Term
Minor Criteria
Definition
fever
hrt condtn
immun phenomena
vascular phenomena
Microbio evidence
Term
Definite
Definition
2 major no minor
1 major 3 minor
no major 5 minor
Term
Possible IE
Definition
1 major 1 minor
no major 3 minor
Term
common indications for surgery in IE
Definition
-CHF -Embolic complications
-vegetation size
-PVE -ABscess
-Refractory sepsis
Term
Need how man yblood cultures every 24-48 hours
Definition
2 blood cultures until clearance of bacteremia
Term
NVE and right sided IE TX is________ Than PVE
Definition
SHORTER
Term
resected tissue positive?
Definition
entire course of Tx occurs after Valve resection
Term
resected tissue Negative?
Definition
duration of Therapy is PVE duration counting days of Tx prior to surgery
Term

NVE Viridans/Bovis Tx

</= 0.12 mcg/ml 4 week regimen

Definition
Penicillin G or Ceftriaxone or Vanco (for confirmed lactam allergy)
Term

NVE Viridans/Bovis Tx

</= 0.12 mcg/ml 2 week regimen

Definition

Penicillin G

or

Ceftriaxone + Gentamicin

Term

Exclusion for Penicillin 2 week Regimen

NVE Viridans/Bovis Tx

</= 0.12 mcg/ml 2 week regimen

Definition

extracardiac disease abscess

CrCl <20ml/min PCN tolerant organism

Term

NVE Viridans/Bovis Tx

PCN MIC 0.12-0.5 mcg/ml

Definition
Pen G 4wks + Gentamicin 2 wks or Ceftri Monotx (SVERE PEN ALLRGY) or Vanco Monotx(SVERE PEN ALLRGY)
Term

NVE Viridans/Bovis Tx

PCN mic >0.5 mcg/ml Nutritionally variant strep

Definition
Pen G + Gentamicin (4-6 weeks) or Vanco Monotx (SVERE PEN ALLRGY)(4-6 weeks)
Term

PVE Viridans/Bovis Tx

PCN susceptible MIC </= 0.12

Definition
Pen G (6 weeks) or Ceftri (6 wks) +/- Gentamicin (2wks) or Vanco Monotx (6wks)
Term

PVE Viridans/Bovis Tx

PCN susceptible/or fully resistant strain MIC > 0.12

Definition
Pen G (6 weeks) or Ceftri (6 wks) + Gentamicin (6wks) or Vanco Monotx (6 wks)
Term
Gentamicin peak
Definition
Peak: 3-5
Term
Gentamicin trough
Definition
Trough <1mcg/ml
Term

Vanco goal trough 

 

(FOR STAPH NVE & PVE?)

Definition

10-20mcg/ml

 

FOR STAPH NVE & PVE:15-20mcg/ml

Term
Enterococcus Tx Pen/Gent susceptible strains
Definition
Penicillin or Ampicillin + Gentamicin
Term
Enterococcus Tx
Pen/Gent susceptible strains DURATION
Definition
NVE & Sx <3 mnths: 4wks
PVE or Sx >3mnths: >/=6wks
Term
Enterococcus Tx
Pen allergic or intrinsic pen resistance
Definition
Vanco + Gentamicin
6 weeks
Term
E Faecalis IE CrCl <50 ml/min
Definition
Ampicillin 2gm IV q 4 h + Ceftri 2gm q 12 h(high dose)
6 weeks
Term
Cephalasporins activity on ENTEROCOCCI
Definition
No activity on enterococci alone
Term
Gentamicin resistance Tx
Definition
Streptomycin: ototoxic
Amp-Ceftri: 6 weeks (low risk nephrotoxicity)
Term
Streptomycin: Avoid in CrCL
Definition
<50ml/min
Term
B-lactamase producing strains or severe vanco allergy
Definition
Amp-sulbactam + Gentamicin
6 weeks
Term
Enterococci Resistance
Definition
Linezolid 600mgIV/PO q12 h
Daptomycin 10-12 mg/kg q24h + amp or ceftaroline
>6 weeks duration
Term
Linezolid monitor
Definition
bone marrow suppression (Thrombocytopenia)
neuropathy
DDI (SSRIs)
Term
Daptomycin caution
Definition
MonoTx not recommended
Term
Daptomycin monitor
Definition
CPK at baseline and weekly
Term
(Coagulase positive)
Definition
Staph Aureus IE
Term
Higher mortality of Staph IE in
Definition
no IV drug abusers
Term
Coagulase negative
Definition
S. epidermidis
Term
NVE: Staph spp Tx (methicillin susceptible)
Definition
Nafcillin or Oxcacillin 12g/24 h in divided doses
6 weeks
(2wk if uncomplicated right side)
Term
Pen allergic NVE Staph spp Tx
Definition
Cefazolin 6g/24h in 3 divided doses
6 weeks
Term
MRSA and Coagulase Neg strains or severe/IgE mediated B-lactam allergy
Definition
Vanco 15-20mg/kg q 8-12h (Trough15-20)
Dapto >/= 8mg q24h
6 weeks
Term
PVE methicillin susceptible Tx
Definition
Nafcillin/Oxcacillin (>/=6 wks) + Rifampin (>/=6wks) +Gentamicin(2weeks)
Term
PVE Pen allergic Tx
Definition
Cefazolin 6g/24h in 3 divided doses >/=6wks + Rifampin (>/=6wks) +Gentamicin(2weeks)
Term
PVE Coag neg strains or severe/IgE mediated B-lactam allergy
Definition
Vanco 15-20mg/kg q 8-12h (Trough15-20) 6 weeks + Rifampin (>/=6wks) + Gentamicin(2weeks)
Term
MRSA bacteremia persisting for >7 days DO WHAT?
Definition
Switch to Daptomycin 10mg/kg/dose IV QD + Gentamicin or Rifampin
Term
Anticoag
Definition
replace warfarin w/ IV heparin
(in case Surgery needed)
Term
Mechanical valve and anticoag
DO WHAT?
Definition
Discontinue all anticoag in pt who had CNS embolic event. Discontinue for first 2 weeks of ABX Tx
Term
NO RENAL ADJUSTMENTS in.....
Definition
Naf/Ox
Ceftri
Rifampin
Term
Ampicillin stability?
Definition
not stable >24 hrs at room temp in pump
Term
Ceftriaxone dosing advantage
Definition
once daily dosing
No renal adj!
Term
Rifampin problem
Definition
Drug interxn
CYP3A4 strong inducer
HEPATOTOXICITY
Term
Daptomycin
Definition
Risk of myopathy
monitor CK weekly
Term
TEE preferred in pt with
Definition
Prosthetic valves
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