Izard - Drugs to treat Myocarditis, Endocarditis, Pericarditis Flashcards
What is the suffix of ACE inhibitors?
Drugs to treat myocarditis
- pril
What is the suffix of angiotensin II receptor blockers?
Drugs to treat myocarditis
-sartan
What are the ACE inhibitors used to treat myocarditis?
Drugs to treat myocarditis
- Benazepril
- Enalapril
- Captopril
- Fosinopril
- Lisinopril
BE CFL (like “be careful”
What is Benazepril?
Drugs to treat myocarditis
ACE inhibitors for
- Myocarditis
- HTN
- HF
Does Benazepril have a sulfa group?
Drugs to treat myocarditis
No
What is Benazepril MOA?
Drugs to treat myocarditis
Benazepril competes with ACE for angiotensin I and blocks its conversion to angiotensin II
What is black box warning for Benazepril?
Drugs to treat myocarditis
- Fetal Toxicity- stop if pregnant
- Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.
What pt population is at risk with Benazepril?
Drugs to treat myocarditis
Black patients–> can develop angioedema
no angioedema? this is a good drug
What should be monitored while on Bezapril?
Drugs to treat myocarditis
- blood pressure
- serum creatinine/BUN
- serum potassium
- serum sodium
Is Captopril a sulfa drug?
Drugs to treat myocarditis
Yes
When is Captopril indicated?
Drugs to treat myocarditis
ACE inhibitor for myocarditis
- hypertension
- congestive heart failure
- various renal syndromes such as diabetic nephropathy and scleroderma.
What are contraindications of Captopril?
Drugs to treat myocarditis
Sulphur allergy
- ACE-inhibitor induced angioedema
- angioedema
- hypersensitivity
- aortic stenosis
What are adverse Reactions of Captopril?
Drugs to treat myocarditis
- abdominal pain
- agranulocytosis
- alopecia
- anaphylactoid reactions
What should be monitored when taking Captopril?
Drugs to treat myocarditis
- blood pressure
- serum creatinine/BUN
- serum potassium
- serum sodium
What is the black box warning for captopril?
Drugs to treat myocarditis
-Fetal toxicity
- Drugs that act directly on the renin-angiotensin
system can cause injury and death to the developing fetus.
Is Enalapril a sulfa drug?
Drugs to treat myocarditis
No, it is favored because it is not a sulfa and has stroke prophylaxis
What are the indications for Enalapril?
Drugs to treat myocarditis
- ACE inhibitor to treat myocarditis
- stroke prophylaxis
- diabetic neuropathy
- heart failure
- HPTN
- proteinuria
What should be monitored while on Enalapril?
Drugs to treat myocarditis
- blood pressure
- LFTs
- serum bilirubin (total and direct)
What is the black box warning for Enalapril?
Drugs to treat myocarditis
-Fetal toxicity
- Drugs that act directly on the renin-angiotensin
system can cause injury and death to the developing fetus.
Is Fosinopril a sulfa drug?
Drugs to treat myocarditis
NO
What is indication for Fosinopril?
Drugs to treat myocarditis
-ACE inhibitor for Myocarditis
- heart failure
- HTPN
- proteinuria
What is the indication of lisinopril?
Drugs to treat myocarditis
HTN-It may be used other classes of antihypertensive agent or alone
HF-adjunctive therapy in patients who are not responding
adequately to diuretics and digitalis.
Acute Myocardial Infarction-indicated for the treatment of hemodynamically stable patients within 24 hours of acute
myocardial infarction, to improve survival
- Patients should receive, as appropriate, the standard recommended treatments such as thrombolytics, aspirin and beta blockers.
What drugs interact with lisinopril?
Drugs to treat myocarditis
Diuretic Therapy
–>excessive reduction of blood pressure after initiation of therapy
Antidiabetics:
- ACE inhibitors and antidiabetic medicines (insulins, oral hypoglycemic agents)–> increased blood-glucose-lowering; risk of hypoglycemia.
Non-steroidal Anti-inflammatory Agents:
- co-administration of lisinopril worsen compromised renal function.
What is the black box warning for Lisinopril?
Drugs to treat myocarditis
-Fetal toxicity
- Drugs that act directly on the renin-angiotensin
system can cause injury and death to the developing fetus.
What is the black box warning of valsartan?
Drugs to treat myocarditis
-Fetal toxicity
- Drugs that act directly on the renin-angiotensin
system can cause injury and death to the developing fetus.
What is valsartan?
Drugs to treat myocarditis
Angiotensin II receptor blocker
What is the indication of Valsartan?
Drugs to treat myocarditis
-Hypertension, to lower blood pressure (Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions)
- Treatment of heart failure
- Post-Myocardial Infarction
Who should be warned about taking valsartan?
Drugs to treat myocarditis
- Fetal/Neonatal Morbidity and Mortality
- Hypotension
- Impaired Hepatic Function
- Impaired Renal Function
What are adverse rxns of Valsartan by system?
Drugs to treat myocarditis
- Body as a Whole: Allergic reaction and asthenia
- Cardiovascular: Palpitations
- Dermatologic: Pruritus and rash
- Digestive: Constipation, dry mouth, dyspepsia, and flatulence
- Musculoskeletal: Back pain, muscle cramps, and myalgia Neurologic and Psychiatric: Anxiety, insomnia, paresthesia, and somnolence
- Respiratory: Dyspnea
- Special Senses: Vertigo
- Urogenital: Impotence
What type of drug is losartan?
Drugs to treat myocarditis
Angiotensin II receptor blocker
What are the indications of Losartan?
Drugs to treat myocarditis
- Treatment of hypertension–> adults and children greater than 6 years old
- Reduction of the risk of stroke in patients with hypertension and left ventricular hypertrophy
- diabetic nephropathy with an elevated serum creatinine and proteinuria in patients with type 2 diabetes and a history of hypertension
What are the warnings of Losartan?
Drugs to treat myocarditis
- Fetal/Neonatal Morbidity and Mortality
- Hypotension
- Impaired Hepatic Function
- Impaired Renal Function
What should you monitor on someone on losartan?
Drugs to treat myocarditis
- blood pressure
- LFTs
- Serum bilirubin
What is the black box warning of Losartan?
Drugs to treat myocarditis
-Fetal toxicity
- Drugs that act directly on the renin-angiotensin
system can cause injury and death to the developing fetus.
How does carvedilol work?
Drugs to treat myocarditis
It is a non selective alpha and beta blocker
What are the indications for using carvedilol?
Drugs to treat myocarditis
- Treatment of mild to severe chronic heart failure
- Treatment of left ventricular dysfunction following myocardial infarction in clinically stable patients
- Treatment of hypertension
What are the warnings of carvedilol?
Drugs to treat myocarditis
- exacerbation of coronary artery disease upon cessation of therapy –>do not abruptly discontinue.
- Bradycardia, hypotension, worsening heart failure/fluid retention may occur. Reduce dose as needed.
- Non-allergic bronchospasm (e.g. chronic bronchitis and emphysema): Avoid -blockers. If deemed necessary, use with caution and at lowest effective dose.
- Diabetes: monitor glucose as beta-blockers may mask symptoms of hypoglycemia or worsen hyperglycemia.
What should be monitored when on carvedilol?
Drugs to treat myocarditis
- Blood pressure
2. Heart Rate
What are the contraindications of Carvedilol?
Drugs to treat myocarditis
- Bronchial asthma or related bronchospastic conditions
- Second- or third-degree AV block
- Severe bradycardia (unless permanent pacemaker in place)
- Severe hepatic impairment
- History of serious hypersensitivity reaction
What type of drug is Bisoprolol? How does it work?
- beta blocker
- Beta 1 selective adrenoceptor blocking agent
What is Bisoprolol used for?
Drugs to treat myocarditis
Used in the treatment for:
- angina
- atrial fibrillation
- atrial flutter
- HF
- HPTN
What are the warnings of bisoprolol?
Drugs to treat myocarditis
- Cardiac Failure
- In Patients Without a History of Cardiac Failure
- Abrupt Cessation of Therapy
What should be monitored when taking bisoprolol?
Drugs to treat myocarditis
- blood pressure
- heart rate
- serum creatinine/BUN
What is Metoprolol?
Drugs to treat myocarditis
Metoprolol is a competitive, beta-1 selective (cardioselevtive) adrenergic agonist used in endocarditis
What is Furosemide?
Drugs to treat myocarditis
Diuretic
What should be monitored on metoprolol?
Drugs to treat myocarditis
- Blood pressure
- Heart Rate
What are the indications of Furosamide?
Drugs to treat myocarditis
- EDEMA
- Drugs Used To Treat Myocarditis- Diuretics
- Furosemide is indicated in adults and pediatric patients for the treatment of edema associated with CHF, cirrhosis of the liver and renal disease, including the nephrotic syndrome
- Furosemide is particularly useful when an agent with greater diuretic potential is desired and is used in adjunctive therapy in acute pulmonary edema
- When rapid onset desired: IV administration of furosemide (i.e. acute pulmonary edema)
- If gastrointestinal absorption is impaired or oral medication is not practical for any reason, furosemide is indicated by the IV or IM route
- Parenteral use should be replaced with oral furosemide as soon as practical
What are furosemide contraindications?
Drugs to treat myocarditis
- Anuria (kidneys can’t produce urine)
- hx of furosemide hypersensitivity
What are warnings/adverse effects of Furosamide?
Drugs to treat myocarditis
- potent diuretic–> potent amounts can cause fluid/ electrolyte imbalance (hyponatremia, hypochloremic alkalosis, hypokalemia, hypo magnesium, hypocalcemia
- dry mouth, thirst, weakness, etc
What are drug interactions with Furosemide?
Drugs to treat myocarditis
May increase OTOTOXICITY in AMINOGLYCOSIDE abx esp with impaired renal function
-Don’t use with ETHACRYNIC ACID –> OTOTOXICITY possibility
What type of drug is Spironolactone?
Drugs to treat myocarditis
Aldosterone antagonist
aldosterone receptor blocker
- drug for myocarditis
What are the indications of Spironolactone?
Drugs to treat myocarditis
- Used in the treatment of HF, reduced ejection fraction to increase survival
- Manage edema
- Reduce the need for hospitalization for HF
- HTN
- Edema assoc. with Hepatic/Nephrotic Syndrome
- Primary Hyperaldosteronism
What are the contraindications of spironolactone?
Drugs to treat myocarditis
- Hypokalemia
- Addison’s Disease
- Concomitant use of Eplerenone
What are warnings of Spironolactone?
Drugs to treat myocarditis
-Hyperkalemia»Monitor serum K+
-Hypotension and worsening renal function»Monitor
-Electrolyte and Metabolic Anomalies: Monitor serum electrolytes uric acid and blood glucose
-Gynecomastia (AE)
What drugs does spirolactone interact with?
Drugs to treat myocarditis
Agents that increaseserum K+»Hyperkalemia
- Lithium: increases Li toxicity
- NSAIDs reduces effect of Aldosterone
What are the ways that pericarditis can present?
- Acute and recurrent pericarditis
- Pericardial effusion without major hemodynamic compromise
- Cardiac tamponade
-Constrictive pericarditis
-Effusive-constrictive pericarditis
How do you manage pericarditis?
Nonsteroidal and Anti-Inflammatory Drugs (NSAIDs) for nearly all patients with acute idiopathic or
viral pericarditis in combination with Colchicine
What is pericarditis treatment duration dependent on?
- resolution of symptoms
2. normalization of C-reactive protein (CRP)
When should glucocorticoids be used in pericarditis?
- initial tx only in patients that have contraindications to NSAIDs
- specific indications –> systemic inflammatory diseases, pregnancy, and possibly renal failure
Who is at risk for GI toxicity risk with NSAID use in pericarditis?
* KNOW THIS*
-NSAIDs can lead to gastrointestinal toxicity (ie, gastritis, ulcers, etc), in high doses or for prolonged periods of time.
–History of peptic ulcer
–Age greater than 65 years
–Concurrent use of Aspirin, Corticosteroids, or Anticoagulants
Who should get treated with concomitant gastroprotective therapy while on NSAIDs for pericarditis?
KNOW
- Pts at risk of GI toxicity
–History of peptic ulcer
–Age greater than 65 years
–Concurrent use of Aspirin, Corticosteroids, or Anticoagulants
What is used as an adjunct to pericarditis tx with NSAIDs to reduce sx, decreaserate of recurrent pericarditis, and is well tolerated?
KNOW
Colchicine
What is the list of NSAIDs?
- Aspirin
- Ketorolac
- Indomethacin
- Ibuprofen
- Flurbiprofen
- Naproxen
- Diclofenac
- Celecoxib
- Meloxicam
What kind of drug is ibuprofen?
Drugs Used To Treat Pericarditis-
NSAID
What are the indications of Ibuprofen?
KNOW
For fast and effective relief of:
–Headache pain (including mild to moderate migraine and tension headache)
- menstrual pain,
- toothache(dental pain),
- pain from inflammation associated with conditions including: arthritis, physical or athletic overexertion, (e.g. sprains or strains),
minor aches and pains in muscles
bones and joints
backache
the aches and pain due to the common cold and flu, reduction of fever
What is a contraindication of ibuprofen
- Active gastric or duodenal ulcer
- GI Bleed
- Hepatic impairment
- Acute liver disease
What are the contraindications of ibuprofen use?
KNOW
- Careful in heart failure, hypertension, fluid retention
- Careful in pts with hx of GI tract irritation, hx of PUD
- increased risk of renal toxicity esp in individuals with impaired renal function, heart failure, and liver dysfunction
What are the adverse effects of Ibuprofen?
- decreased appetite
- edema
- fluid retention
What is the indication of Colchine?
- Gout treatment (acute flares)
- Pericarditis, acute or recurrent (treatment) (off-label use)
- Patients with acute idiopathic or viral pericarditis
What drugs does colchine interact with?
CYP3A4 inhibitors
What should empiric tx for infectious endocarditis cover?
- Staphylococci (MSSA and MRSA),
- Streptococci,
- Enterococci
What are considerations in infective endocarditis management?
- Obtain an Infectious Disease consult
- Empiric antibiotics should cover Staphylococci (MSSA and MRSA), Streptococci, and Enterococci
- Vancomycin is a reasonable initial therapy
- IV Antibiotic therapy should be ultimately be targeted to the organism isolated on blood culture (see IDSA Guidelines)
- Typical IV antibiotic duration is 4-6 weeks depending on type of infection
What are indications for Vancomycin?
- Septicemia
- Infective Endocarditis
- Skin and Skin Structure
Infections
- Bone Infections
- Lower Respiratory Tract Infections
What are adverse runs of vancomyocin (endocarditis tx)
- anaphylaxis,
- “red man syndrome”
- acute kidney Injury
- hearing loss
- neutropenia
What are warnings of Vancomyocin?
- Infusion Reactions
- Nephrotoxicity
- Ototoxicity
- C. Difficile associated diarrhea
- Neutropenia
- Phlebitis
- Development of drug-resistant bacteria
What are drug rxns of vancomycin?
• Anesthetic Agents: Concomitant administration of vancomycin and anesthetic agents has been associated with erythema and histamine-like flushing.
