Cardio: Drugs for Myocarditis, Endocarditis, and Pericarditis Flashcards
Suffix of all ACEi?
-pril
Suffix of all ARBs?
-sartan
Black box warning of all ACEi and ARBs?
Embryotoxic!
-do not give if pt pregnant or if breastfeeding
What should you monitor for all ACEi?
- Blood pressure: check for decrease
- Serum Creatinine/BUN: can cause early rise
- Serum K+: can increase
- Serum Na+: can decrease
Adverse reactions to ACEi?
Alopecia, angioedema, angina, anaphylactoid reactions
Contraindications to ACEi?
Angioedema, Aortic stenosis, Black patients may tolerate worse
What can all ACEi be used to treat?
Heart failure and HTN
Which of the ACEi have a sulfa allergy associated with them?
Captopril
Which of the ACEi would you prescribe in someone for stroke prophylaxis?
Enalapril
Which of the ACEi drugs be used in renal syndromes, such as proteinuria and diabetic neuropathy?
captopril, enapril, fosinopril
Fosinopril is used in combo with what drug to increase efficacy?
Thiazide diuretics
-ie Hydrochlorothiazide
Which ACEi is given post-MI to reduce mortality?
Lisinopril
When prescribing lisinopril, what drug-drug interactions should you watch out for?
Diuretics
-can drastically reduce BP
Anti-diabetics
-can increase glucose lowering, causing hypoglycemia
NSAIDs
-combo can cause AKI
Indications for ARBs?
HTN
-lowering BP reduces CV events like strokes and MI
Which of the ARBs is used in children?
Losartan
-can be used to lower BP in children as young as 6yo
Adverse effects of all ARBs?
Hypotension, impaired renal fxn, impaired hepatic fxn
What should you monitor when prescribing an ARB?
BP,
LFTs
Serum Bilirubin
MOA of Carvedilol?
Mixed a1 and non-selective B-blocker
Indications for all B-Blockers?
Heart Failure,
HTN
Left ventricular dysfunction in stable pts
Which B-blockers could you give for A-fib and A-flutter?
Bisoprolol and Metoprolol
-probably others, but this is what he lists
Which B-blocker can you give for unstable angina?
Metoprolol
When taking a patient off a B-Blocker, what is important to remember?
Taper them off
-abrupt cessation can exacerbate CAD
Would you give a B-blocker in someone with Asthma, COPD or bronchospasm?
NOPE
-the cardioselective ones would be your best bet if you HAD to use a B-blocker though
What would you monitor when giving a B-blocker?
BP, HR
Serum creatinine/BUN (bisoprolol)
Which of the B-blockers can cause HF and LV dyfunction following MI?
Carvedilol
Also look out for hyperglycemia, asthenia, and bradycardia
Which drugs would you give for edema?
Furosemide (very effective!) and Spironolactone
What do you need to watch out for when giving furosemide?
Water/electrolyte depletion
-so look for signs of dehydration, hypotension, hypocalemia, hyponatremia!, muscle cramps, etc
Furosemide and aminoglycosides can cause what?
Ototoxicity, especially in those with renal impairment
Would you give furosemide with ethacrynic acid?
Nah fam, can cause ototoxicity
-both do the same thing anyway
MOA of spironolactone?
Aldosterone antagonist
MOA of furosamide?
Inhibits NKCC2 transporter
Indications for Spironolactone?
HF, edema, HTN, Primary hyperaldosteronism
What do you need to look out for when prescribing spironolactone?
Hyperkalemia (peaked T waves??)
Hypotension/worsening renal fxn
Electrolyte disturbances
Gynecomastia
A 55yo male comes into your office complaining of impoetence and “growing boobs” after taking a drug for his ascites due to cirrhosis. What drug is he taking?
Spironolactone
-aldosterone inhibitor that isn’t specific, so inhibits testosterone as well
What drugs does spironolactone interact with?
Lithium (toxicity)
NSAIDs reduce effect of aldosterone
–increases K+ more?
When would you se Glucocorticoids for pericarditis?
If contra to NSAIDs
What should you be considerate of when giving NSAIDs?
Active bleeds, Ulcers, and gastritis, especially in elderly
NSAIDs would be contraindicated if any of these present!
Warnings when prescribing NSAIDs?
HF, HTN
GI irritation
Renal toxicity, especially if on diuretics
What is first line in treating pericarditis?
Indomethacin and Colchicine
-from Selby
What is the label and off label use of Colchicine?
Label: gout
Off: pericarditis
What drug-drug interactions should you be mindful of with colchicine?
those that interact w CYP3A4
Would you prescribe colchicine in those with renal/hepatic impairment?
NO
Adverse effects of colchicine?
GI Upset (diarrhea, N/V)
If a patient has signs and symptoms of infectious endocarditis, what should you treat with?
Vancomycin until you find out the specific bug
How long does it take to treat infectious endocarditis?
4-6 weeks
Adverse reactions to vancomycin?
Anaphylaxis, “red man” syndrome, AKI, hearing loss, neutropenia
Watch out for infusion reactions (phlebitis), ototoxicity and C. diff
