Drugs for Endo- Myo- and Pericarditis (Iszard) Flashcards
What two drug classes are use to treat myocarditis?
ACE inhibitors -Prils
Angiotensin II blockers -Sartans
What are the indications for Benazepril?
manage HTN
treat heart failure
What is the MOA for Benazepril?
Competes with ACE thereby blocking its AGTI to AGTII
What are the adverse reactions to Benazepril?
Alopecia
Anaphylactoid Rxn
Angina
Angioedema
Anxiety
What are the contraindications for Benazepril?
ACEi induced angioedema
angranulocytosis
hypersensitivity
aortic stenosis
Black patients
Bone marrow supression
breast feeding
cardiomypathy
cerebrovascular dz
children
What parameters should be monitored in patients on Benazepril?
Blood Pressure
Serum Crt/BUN
K/Na
What are the contraindications for Catopril?
Sulfur allergy
ACEi induced angioedema
angioedema
hypersensitivity
aortic stenosis
What are the adverse reactions to Captopril?
abdominal pain
agranulocytosis
alopecia
anaphylactoid reaction
What are the monitoring parameters for Captopril?
BP
CRt/BUN
K/Na
What is the main indication for Enalapril?
Stroke Paraphylaxis
What is the black box warning for the “Prils”
fetal toxicity when pregnancy is detected-stop ASAP
In addition to Lisinopril used for HTN and HF, it can also be given post acute MI to do what?
given within 24hours of acute MI improves survival
What are the drug-drug interactions of Lisinopril?
patients on diuretics may experience drastic reduction in BP
Patients on ACEi and antidiabetics may increase risk of hypoglycemia
Patients on NSAIDs may have worsening renal function
What are the warnings/precautions of Valsartan?
fetal morbidity/mortality
hypotension
impaired hepatic and renal fxn
What are the adverse reactions for Valsartan?
allergic reaction
palpitations
rash
constipation
myalgias
anxiety
dyspnea
vertigo
impotence
What are the monitoring parameters for Losartan?
BP
LFTs
Serum bilirubin
What are the indications for Losartan?
HTN
reduce risk of stroke in those with HTN or LV hypertrophy
Treat diabetic nephropathy
What is the indication for Carvedilol?
Beta blocker for myocarditis, severe chronic HF, LV dysfunction, HTN
What are the indications for Bisoprolol and Metoprolol?
Myocarditis, agina, A fib, a flutter, HF, HTN
Furosemide can be used to treat myocarditis and is indicated when?
what is a prominent drug interaction?
when edema is present
Ototoxicity especially in the presence of impaired renal function (Don’t use with Ethacrynic acid)
Spironolactone is an aldosterone receptor blocker than can be used to treat what?
Two main warnings?
Myocarditis
Hyperkalemia, monitor K
Gynecomastia
What are the main treatments for pericarditis?
NSAIDs for anyone with acute idiopathic or viral pericarditis combined with Colchicine
Duration of treatment for pericarditis is dependent on what?
resolution of sx and normalization of CRP
If NSAIDs are contraindicated, what should be used to treat pericarditis?
Glucocorticoids
Since NSAIDs can cause GI toxicity, how should treatment to pericarditis be approached?
Consider risks: peptic ulcer disease, age over 65, other NSAIDs, ASA, corticosteroids, or anticoag.
Use for shortest interval as possible and consider use of PPIs with NSAIDs
What are the indications for the NSAID Ibuprofen?
what are the contraindications?
HA, menstrual pain, dental pain, inflammation, myalgias, cold/flu, and fever
Active gastric or duodenal ulcer
What are the warnings/precautions for ibuprofen?
caution in those with HF, HTN
caution in patients>GI tract irritation
increased risk of renal toxicity
What are the indications for Colchicine?
What are the contraindications?
Gout
Pericarditis
Renal/hepatic impairment
CYP inhibitors
What are the warnings for Colchicine?
monitor for toxicitiy and consider lowering dose or D/C
What are the adverse reactions to Colchicine?
What are the drug interactions?
GI upset
Coadministration with CYP3A4 inhibitors
What type of agents are necessary for infective endocarditis?
bactericidal agents
Make sure to optimize sustained bactericidal serum concentrations throughout as much of the dosing interval as possible
How to approach empiric therapy for infective endocarditis?
Therapy should be targeted to the organism isolated from blood cx
if subacute, empiric therapy is not always necessary and therapy can await cultures (1-3 days)
If suspecting acute infective endocarditis, what is the protocol?
obtian ID consult
Abx should cover MSSA, MRSA, Streptococci and Enterococci
Once hemodynamically stable, can continue IV therapy as outpatient
Counsel on need for immediate evaluation if sx worsen
IV abx duration for 4-6 weeks
Vanc is reasonable inital therapy
What are the indications for Vanc?
What are the contraindications?
What are the adverse reactions?
septicemia, infective endocarditis, skin infections, bone infections, LRI
Hypersenstivity
Anaphylaxis, red man syndrome, AKI, hearing loss, neutropenia
what are the warnings for Vanc?
infusion reactions
nephrotox
ototox
C. diff
neutropenia
phlebitis
drug resistance
What are the drug interactions of Vanc?
combining with anesthetic agents has been assx with erythema and flushing
Benazopril does not contain what group, thus making it a very safe drug?
It does NOT contain a sulfhydryl group
Fosinopril, like Benazopril, does not contain what?
What happens when it is used in combination with thiazide diuretics?
A sulfhydryl group.
A greater BP lowering effect
What is the main warning for Carvedilol?
Acute exacerbation of CAD with cessation
Do not stop abruptly
What are the main contraindications for Carvedilol?
Bronchial Asthma or related bronchospastic conditions
What are the contraindications for bisoprolol and metoprolol?
Acute bronchospasm
Acute HF
Asthma
**Avoid abrupt D/C (uncovering adrenergic receptors) as response tachy and HTN may occur
What is the main warning for Bisoprolol?
Abrupt cessation of therapy
What are the adverse effects of Furosemide?
All pt’s receiving furosemide should be observed for these signs or symptoms of fluid or electroplyte imbalance
What is the benefit of adding Colchicine to NSAIDs for pericarditis?
Reduces sx
decreases rate of recurrent pericarditis and is well tolerated
