Drugs to Treat Myocarditis, Endocarditis, & Pericarditis (Iszard)

Question 1

What is the common ending for ACE inhibitors used to treat myocarditis?

Answer 1

-pril

Question 2

What are the ACE inhibitors used to treat myocarditis (only the ones discussed in the lecture)?

Answer 2

• • Benazepril
• • Captopril
• • Enalapril
• • Fosinopril
• • Lisinopril

Question 3

What is the common ending for angiotensin II receptor blockers used to treat myocarditis?

Answer 3

-artan

Question 4

What are the angiotensin II receptor blockers used to treat myocarditis (only the ones discussed in the lecture)?

Answer 4

• • Losartan

- - Valsartan

Question 5

This ACE inhibitor is used in the management of HTN and treatment of heart failure by reducing injection fraction.

Answer 5

Benazepril

Question 6

Why is Benazepril better in regards to safety for some patients?

Answer 6

It has no sulfhydryl group, so it’s good for patients with a sulfur allergy

Question 7

Explain the MOA for ACE inhibitors.

Answer 7

Compete with ACE (angiotensin-converting enzyme) for the substrate angiotensin I, thereby blocking its conversion to angiotensin II.

***Remember, angiotensin II is what goes on to cause aldosterone release and thus sodium and water retention causing high BP!

Question 8

What is the black box warning for all the ACE inhibitors and angiotensin II receptor blockers to treat myocarditis?

Answer 8

Fetal Toxicity – when pregnant need to d/c use ASAP. Drugs that act directly on renin-angiotensin system can cause injury and death to fetus.

Question 9

What are the monitoring parameters used for the ACE inhibitors (except Enalapril)?

Answer 9

• • BP
• • Serum creatinine/BUN
• • Serum potassium
• • Serum sodium

Question 10

What are the monitoring parameters for Enalapril?

Answer 10

• • BP
• • LFTs
• • Serum bilirubin (total and direct)

Question 11

This ACE inhibitor is used in the treatment of HTN, CHF, and various renal syndromes such as diabetic nephropathy and scleroderma.

Answer 11

Captopril

Question 12

What are the main adverse reactions for Captopril?

Answer 12

• • Abdominal pain
• • Agranulocytosis
• • Alopecia
• • Anaphylactoid reactions

Question 13

A major contraindication for Captopril is what?

Answer 13

Sulfur allergy – it contains sulfur

Question 14

This ACE inhibitor is used in the treatment of diabetic neuropathy, heart failure, HTN, proteinuria, and stroke prophylaxis. It has no sulfur.

Answer 14

Enalapril

Question 15

Enalapril has special clinical use for prophylaxis of what?

Answer 15

Stroke

Question 16

This ACE inhibitor is used for the treatment of heart failure, HTN, and proteinuria. It also does NOT contain a sulfhydryl group.

Answer 16

Fosinopril

Question 17

Use of Fosinopril in combination with _______ _______ gives a BP-lowering effect greater than that seen with either agent alone.

Answer 17

Thiazide diuretics

Question 18

This ACE inhibitor is used in the treatment of HTN, heart failure, and acute MI.

Answer 18

Lisinopril

Question 19

Lisinopril may be used alone as an initial therapy for ________ or concomitantly with other classes of similar agents.

Answer 19

HTN

Question 20

T/F. Lisinopril is used as an initial therapy for heart failure and is best when given by itself.

Answer 20

False. Lisinopril is indicated as adjunctive therapy in the management of heart failure in patients who are not responding adequately to diuretics and digitalis.

Question 21

This ACE inhibitor is indicated for the treatment of hemodynamically stable patients within 24 hours of acute MI, to improve survival.

Answer 21

Lisinopril

Question 22

What are the drug-drug interactions of patients taking Lisinopril?

Answer 22

• • Patients on diuretic therapy
• • Antidiabetics
• • NSAIDs

Question 23

What can happen if a patient takes Lisinopril that is also on diuretic therapy?

Answer 23

They may occasionally experience an excessive reduction of BP after initiation of therapy

Question 24

What can happen if a patient takes Lisinopril along with antidiabetic medication?

Answer 24

May cause an increased blood-glucose lowering effect with a risk of hypoglycemia.

Question 25

What can happen if a patient takes Lisinopril along with NSAIDs?

Answer 25

In some patients with compromised renal function who are being treated with NSAIDs, taking Lisinopril may result in further deterioration of renal function.

Question 26

This is an angiotensin II receptor blocker that is used to treat HTN, heart failure, and post-MI.

Answer 26

Valsartan

Question 27

What are the warning/precautions associated with Valsartan and Losartan?

Answer 27

• • Fetal/Neonatal Morbidity and Mortality
• • Hypotension
• • Impaired Hepatic Function
• • Impaired Renal Function

Question 28

This is an angiotensin II receptor blocker that is used to treat HTN, reduce risk of stroke, and treatment of diabetic nephropathy?

Answer 28

Losartan

Question 29

Losartan reduces the risk of stroke in patients with what prior issues?

Answer 29

• • HTN

- - LV hypertrophy

Question 30

Losartan is used in the treatment of diabetic nephropathy with an elevated serum ________ and ________ in patients with T2DM and hx of HTN.

Answer 30

Creatinine

Proteinuria

Question 31

What are the monitoring parameters used for Losartan?

Answer 31

• • BP
• • LFTs
• • Serum bilirubin (total and direct)