Drug Induced Cardiac Injury Flashcards

1
Q

3 Mechanisms of Drug Induced Cardiac Injury

A

QTc Prolongation (Torsades de Pointes)
HF
Myocardial Ischemia

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2
Q

Normal QTc

A

men < 470
women < 480

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3
Q

QTc prolongation

A

> /= 500
/= 60 increase from baseline

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4
Q

Meds that cause QTc Prolongation ABC’s
A:

A

Antiarrhythmics:
- amiodarone
- sotalol
- dofetilide

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5
Q

Meds that cause QTc Prolongation ABC’s
B:

A

Antibiotics:
- Fluoroquinolones (-floxacin)
- macrolides (erythromycin, clarithromycin, azithromycin, etc.)

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6
Q

Meds that cause QTc Prolongation ABC’s
C:

A

Antipsychotics:
- chlorpromazine
- fluphenazine
- perphenazine
- prochlorperazine
- haloperidol

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7
Q

Meds that cause QTc Prolongation ABC’s
D:

A

Antidepressants:
- Citalopram
- TCAs (Amitriptyline, Doxepin, Imipramine, Nortriptyline, etc.)

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8
Q

Meds that cause QTc Prolongation ABC’s
E:

A

Antiemetics:
- ondansetron

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9
Q

Meds that cause QTc Prolongation ABC’s
F:

A

Antifungals:
- azole antifungals

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10
Q

TdP Prevention

A
  • avoid agents in pats with baseline QTc > 450
  • reduce/DC if pats QTc increases > 60 from baseline
  • DC if QTc > 500
  • Maintain K>4 and Mg>2
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11
Q

TdP Treatment

A
  • DC offending agent
  • Mg push or infusion (push if no pulse)
  • Transcutaneous pacing
  • Isoproterenol infusion ($$$, can use epinephrine or atropine instead)
  • if hemodynamically unstable -> cardioversion or defibrillation
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12
Q

3 main causes of drug induced HF

A
  • Sodium and volume retention
  • Direct cardiotoxicity -> cardiomyopathy
  • Negative inotropy
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13
Q

Agents that cause sodium and volume retention (HF)

A
  • NSAIDs
  • Steroids
  • Thiazolidinediones (TZDs)
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14
Q

Agents that cause cardiomyopathy

A
  • Chemotherapeutic agents (anthracyclines, alkylating agents)
  • Trastuzumab
  • Alcohol
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15
Q

Agents that cause Negative Inotropy

A

NDCCBs (diltiazem, verapami)
Beta blockers (-olol)

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16
Q

Anthracycline induced cardiomyopathy

A

Most common agents: doxorubicin, daunorubicin

Risk factors:
- cumulative dose > 400 mg/m^2
- limit dose to 550 mg/m^2

Prevention:
- Dexrazoxane

17
Q

Trastuzumab induced cardiomyopathy

A

Inhibition of HER2 receptors
Evaluate LVEF in all pats prior to and during treatment

Treatment:
- dose adjust/DC
- consider ACE/ARB or BB to treat HF

18
Q

3 mechanisms of drug induced myocardial ischemia

A
  • Increased HR and contractility -> increased myocardial O2 demand
  • Vasospasm -> decreased myocardial O2 supply
  • Drug induced ACS
19
Q

Agents that cause increased O2 demand

A
  • cocaine
  • beta agonists (albuterol)
  • sympathomimetics
  • withdrawal of beta blockers
  • potent vasodilators
20
Q

Agents that cause vasospasm

A
  • cocaine
    -triptans
21
Q

Agents that cause drug induced ACS

A
  • cocaine
  • COC
  • NSAIDs
  • estrogens
  • antimigraine agents
  • HIV agents
  • rosiglitazone
22
Q

Cocaine Induced MI Treatment

A

Chest pain
- ASA
- benzodiazepines

Persistent HTN
- benzodiazepines
- IV nitroglycerin

Other acute ACS treatment
- possibly avoid BB

23
Q

NSAID induced cardiotoxicity

A

Arachidonic acid cascade -> vasoconstriction + platelet aggregation

risk is highest first 7 days of therapy

duration of therapy does not appear to increase risk

Risky doses:
- >1200mg/day ibuprofen
- >750mg/day naproxen