Drugs to Treat Endocarditis, Myocarditis, and Pericarditis Flashcards
What are the classes of drugs used to treat myocarditis?
1) ACE inhibitors
2) Angiotensin II receptor blockers
3) Beta blockers
4) Diuretics
5) Aldosterone-Receptor blocker
What ACE inhibitors are used to treat myocarditis?
-pril:
1) Benazepril
2) Captopril
3) Enalapril
4) Fosinopril
5) Lisinopril
What are the Angiotensin II receptor blockers used to treat myocarditis?
-artan:
1) Losartan
2) Valsartan
In the treatment of myocarditis, what is benazepril indicated for?
Management of HTN and Tx of heart failure
What does benazepril not contain which makes it different from other ACE inhibitors with regard to safety profile?
Sulfhydryl group
What population is benazepril contraindicated for?
Why?
1) Black patients
2) Greater chance of causing angioedema
Captopril similarly to benazepril is indicated for treatment of HTN and congestive heart failure but also?
Diabetic neuropathy and scleroderma
What contraindication is common with captopril?
What should be used instead?
1) Sulphur allergy
2) Benazepril, enalapril, or fosinopril
Besides being used for the treatment of myocarditis, enalapril is indicated for?
Stroke prophylaxis
Fosinopril similarly to the other ACE inhibitors is indicated for treatment of HTN and heart failure but also?
Proteinuria
Fosinopril in combination with what other drug gives a blood pressure lowering effect greater than that seen with either agent alone?
Thiazide diuretics
Lisinopril similarly to the other ACE inhibitors is indicated for treatment of HTN and heart failure but also?
Acute MI
What drug-drug interaction is seen with lisinopril and patients on diuretic therapy?
Hypotension
What drug-drug interaction is seen with lisinopril and patients on antidiabetics?
Hypoglycemia
What drug-drug interaction is seen with lisinopril and patients on NSAIDs?
Damage renal function
What black box warning is associated with the ACE inhibitors?
Fetal toxicity
What contraindication is seen with the ACE inhibitors?
Angioedema
What parameters do you want to monitor when administering ACE-inhibitors?
1) BP
2) Creatinine/BUN
3) Potassium
4) Sodium
What is Valsartan indicated for?
Treatment of HTN, heart failure, and post MI
What is Losartan indicated for?
1) Treatment of HTN in adults and children greater than 6
2) Reduce risk of stroke
3) Treatment of diabetic nephropathy
What black box warning do the Angiotensin II Receptor Blockers have?
Fetal toxicity
What warnings/precautions are associated with Angiotensin II Receptor Blockers?
1) Hypotension
2) Impaired hepatic function
3) Impaired renal function
What beta blockers are used in the treatment of myocarditis?
1) Carvedilol
2) Bisoprolol
3) Metoprolol
What receptors does carvedilol block?
Alpha-and nonselective beta-blocker
What receptor does Bisoprolol block?
Beta-1
What receptor does Metoprolol block?
Beta-1
What warning is associated with beta blockers?
Avoid abrupt cessation of therapy
What contraindication is seen with beta blockers?
Bronchospasm and asthma
What diuretic used to treat myocarditis?
Furosemide
What is furosemide indicated for?
Treatment of edema associated with CHF
What warning is associated with furosemide?
Profound diuresis can cause water/electrolyte depletion
When should parenteral furosemide be replaced with oral furosemide?
As soon as practical
What drug-drug interaction does furosemide commonly have?
This may increase the potential of?
Especially in the presence of?
1) Aminoglycoside antibiotics
2) Ototoxicity
3) Impaired renal function
Furosemide should also not be used concomitantly with what drug due to possibility of ototoxicity?
Ethacrynic acid
What aldosterone antagonist is used to treat myocarditis?
Spironolactone
What warnings/precautions are associated with spironolactone?
1) Hyperkalemia
2) Gynecomastia
What is used as management for acute idiopathic or viral pericarditis?
NSAIDS in combination with colchicine
The duration of treatment of pericarditis is based upon?
1) Resolution of symptoms
2) Normalization of CRP
What should be used for initial treatment of acute pericarditis only in patients with contraindications to NSAIDs?
Glucocorticoids
What contraindication is associated with ibuprofen?
Active gastric or duodenal ulcer
What drug interactions are seen with colchicine?
CYP3A4 inhibitors
What are necessary for effective treatment of endocarditis?
Bactericidal agents
What is the critical first step in designing a management strategy for endocarditis?
Accurate diagnosis from blood cultures
Empiric antibiotics should cover?
1) Staphylococci
2) Streptococci
3) Enterococci
What is a reasonable initial therapy for endocarditis?
Vancomycin
Concomitant administration of vancomycin and anesthetic agents has been associated with?
Erythema and histamine-like flushing
