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- What are the most common signs of endocarditis (vascular/immune)? (4)
- What are some common causes of IE in an abnor- mal heart?
splinter hemor- rhages, osler nodes, janeway spots, roth spots
- Dental manipulation
- Tonsillectomy
- Urological manipula- tion
- Surgical procedure
- Childbirth
- Bacteremia in
- What are common causes of IE in a normal heart? • Intravenous drug therapy
- Pt's with IE in which heart valve have the worst prognosis?
- Which valve is most commonly affected in pt's with IVDA?
Aortic
Triscuspid
- Which valve is least commonly affected by IE? Pulmonic
- What sx's are associated with an acute IE infec- tion?
- What sx's are associated with a subacute IE infec- tion?
- How many sets of blood cultures should be ob- tained in pt's with suspected IE?
- Which pathogen most commonly causes IE?
- High grade fever
- Chills, sweats
- Sepsis
- Murmur
- Low grade fever
- Malaise
- Fatigue
- Weight loss
3 over a period of 24 hrs
- Which pathogens are likely to cause IE in pt's who have had recent dental procedures?
- Which pathogen is the most common cause of IE in pt's with prosthetic valves?
- Antibiotic selection for infective endocarditis is most dependent on which two factors?
- What phenomenon refers to the fact that high bac- terial density renders antimicrobial activity less ef- fective?
- Will MIC in vitro may be higher or lower than the effective MIC at the infection site according to the inoculum effect?
- Which drug class binds to penicillin binding pro- teins (PBPs) to inhibit cell wall synthesis?
- Which 2 penicillins have activity against both Staphylococcus and streptococcus?
- Which 2 drug classes have efficacy based on time above the MIC?
- Which cephalosporin drug has activity against both Staph and Strep?
- What is the Vancomycin trough range that you aim for in pt's with severe infections?
- Before which dose of Vanco should you check the plasma concentration? And should you check the peak or trough?
Staphylococcus au- reus
Viridans streptococ- cus, HACEK
Staphylococcus epi- dermidis
cultures and suscepti- bility
Inoculum Effect
lower
Beta-Lactams (Peni- cillins and Cephalosporins)
Nafcillin and Oxacillin
Penicillins and Cephalosporins
Cefazolin
15-20 mcg/mL
4th dose, when steady state is reached/ Trough
Which drug has ADEs of ototoxicity, nephrotoxicity, neuromuscular paralysis?
- Which drug is static against S. aureus and entero- cocci, cidal against streptococcus, and approved for use with enterococcus resistant to PCN, AG, and vanco?
- Which drug has been proven to improve killing in PVE caused by staphylococci?
- What drug is a strong inducer and increases the metabolism of other drugs such as warfarin, amio- darone, and metoprolol?
- If NVE is caused by staph aureus (non-MRSA), what is the appropriate treatment?
- What antibiotic regimen should be initiated in a pt with tricuspid valve endocarditis (2/2 IVDA) for which cultures results are not yet available?
- What drug combinations should be used for ente- rococcal endocarditis?
- What drug combination should be used in IE caused by PCN resistant enterococcus?
- Which drug should be used to treat Enterococcus NVE or PVE if pathogen is resistant to Penicillin, Vanco, and Gentamycin?
- For which pathogen is double beta lactam therapy used?
Linezolid
Rifampin
Rifampin
Nafcillin or oxacillin
Vanco plus either ceftriaxone or gen- tamycin
Ampicillin/penicillin G plus gentamicin (pre- ferred therapy) or ampicillin plus cef- triaxone (preferred for renal impairment or gentamycin resis- tance)
Vancomycin plus gen- tamicin
Daptomycin or Line- zolid
Enterococcal
- Which drug should be used to treat NVE caused by staph aureus (non MRSA) in pt's with minor PCN allergy?
- Which drug should be used to treat NVE caused by Staph aureus resistant to vancomycin?
- What is the 1st line prophylaxis drug for endocardi- tis?
- What drug must replace gentamicin in the setting of abnormal renal function?
- Which drug(s) should be used to treat PVE caused by penicillin susceptible VGS?
- Which drug(s) should be used to treat PVE caused by penicillin susceptible VGS in pt's with PCN aller- gy?
- What antibiotic regimen should be used for prophy- laxis in pt's with PCN allergy?
Cefazolin
Daptomycin
Amoxicillin
Ceftriaxone
Penicillin G with or without Gentamycin
Ceftriaxone (minor al- lergy) or Vanco (se- vere allergy) with or without Gentamycin
Clar- ithromycin/Azithromycin
