Drugs for Endo- Myo- and Pericarditis (Iszard) Flashcards by Monika Eszterhazy

What two drug classes are use to treat myocarditis?

ACE inhibitors -Prils

Angiotensin II blockers -Sartans

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What are the indications for Benazepril?

manage HTN

treat heart failure

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What is the MOA for Benazepril?

Competes with ACE thereby blocking its AGTI to AGTII

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What are the adverse reactions to Benazepril?

Alopecia

Anaphylactoid Rxn

Angina

Angioedema

Anxiety

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What are the contraindications for Benazepril?

ACEi induced angioedema

angranulocytosis

hypersensitivity

aortic stenosis

Black patients

Bone marrow supression

breast feeding

cardiomypathy

cerebrovascular dz

children

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What parameters should be monitored in patients on Benazepril?

Blood Pressure

Serum Crt/BUN

K/Na

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What are the contraindications for Catopril?

Sulfur allergy

ACEi induced angioedema

angioedema

hypersensitivity

aortic stenosis

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What are the adverse reactions to Captopril?

abdominal pain

agranulocytosis

alopecia

anaphylactoid reaction

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What are the monitoring parameters for Captopril?

CRt/BUN

K/Na

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What is the main indication for Enalapril?

Stroke Paraphylaxis

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What is the black box warning for the “Prils”

fetal toxicity when pregnancy is detected-stop ASAP

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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

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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

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What are the warnings/precautions of Valsartan?

fetal morbidity/mortality

hypotension

impaired hepatic and renal fxn

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What are the adverse reactions for Valsartan?

allergic reaction

palpitations

rash

constipation

myalgias

anxiety

dyspnea

vertigo

impotence

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What are the monitoring parameters for Losartan?

LFTs

Serum bilirubin

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What are the indications for Losartan?

HTN

reduce risk of stroke in those with HTN or LV hypertrophy

Treat diabetic nephropathy

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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