Lecture 5: Drugs to Treat Myocarditis, Endocarditis, Pericarditis

Question 1

What are 5 ACE inhibitors used to treat Myocarditis? (B/C/E/F/L)

Answer 1

Benazepril, Captopril, Enalapril, Fosinopril, Lisinopril

• all end in the suffix “-pril”

Question 2

What are 2 Angiotensin II Receptor blockers used to treat Myocarditis? (L/V)

Answer 2

Losartan and Valsartan

• all end in suffix “-sartan”

Question 3

What is the major Black Box warning of use of ACE inhibitors and Angiotensin II Receptor blockers?

Answer 3

FETAL TOXICITY

• discontinue ASAP if pregnancy is detected

Question 4

What do these drugs treat:

Benzepril (2)
Captopril (4)
Enalapril (4)
Fosinopril (3)
Lisinopril (3)

Answer 4

B - HTN and HF
- no sulfhydryl group

C - HTN, HF, diabetic neuropathy, scleroderma (renal)
- HAS sulfhydryl group = SULFUR ALLERGY

E - HTN. HF, diabetic neuropathy, proteinuria
- STROKE PROPHYLAXIS; no sulfhydryl group

F - HTN, HF, proteinuria
- no sulfhydryl group

L - HTN, HF, acute MI
- do not use with pts. who are hypersensitive

Question 5

What are 4 common contraindications to ACE inhibitor use (A/A/H/AS) and what are 4 common adverse effects of use (AP/A/A/AR)?

Answer 5

Contraindications:

• allergy to sulphur
• ACEi induced angioedema
• ACEi hypersensitivity
• aortic stenosis

Adverse Effects:

• abdominal pain
• agranulocytosis
• alopecia
• anaphylactoid reactions

Question 6

How does Fosinopril interact with thiazide diuretics?

Answer 6

• combination gives a blood pressure-lowering effect greater than that seen with either agent alone

Question 7

How does Lisinopril interact with Antidiabetic medications and NSAIDs?

Answer 7

Antidiabetics:
- concomitant administration may cause inc. blood glucose lowering effects with risk of HYPOGLYCEMIA

NSAIDs:
- co-administration in pts. taking NSAIDs for compromised renal function may have further deterioration of renal function

Question 8

What are Valsartan (3) and Losartan (3) used to treat?

What are 4 warnings of drug use? (FM/H/IRF/IHF)

Answer 8

V: HTN, HF, post-MI
- can cause allergic rxn, vertigo, and impotence

L: HTN, diabetic neuropathy, dec. stroke in pts. with HTN and left ventricular hypertrophy

W: fetal mortality, hypotension, impaired renal function, impaired hepatic function

Question 9

What are 3 common Beta Blockers used to treat Myocarditis? (C/B/M)

What are warnings/contraindications of use?

Answer 9

Carvedilol - combined alpha/nonselective beta blocker

• don’t abruptly stop –> acute CAD exacerbation
• bronchial asthma or bronchospastic conditions

Bisoprolol - beta 1 selective adrenoceptor blocker

• don’t abruptly stop
• CI: acute bronchospasm, acute HF, asthma

Metoprolol - competitive, B1 selective adrenergic antagonist (cardioselective)

• don’t abruptly stop
• CI: acute bronchospasm, acute HF, asthma

Question 10

What diuretic and Aldosterone receptor blocker are used to treat Myocarditis?

Answer 10

Diuretic: Furosemide

ARB: Spironolactone

Question 11

Furosemide and Myocarditis

What is its major drug interaction that can inc. ototoxic potential?

Answer 11

• used to treat edema due to wide variety of conditions (too much leads to profound water/electrolyte depletion)
• inc. ototoxic potential of aminoglycoside antibiotics, especially in the setting of impaired renal function (avoid this combination except in life-threatening situations)
  • do NOT use with ethacrynic acid

Question 12

Spirolactone and Myocarditis

What are 3 contraindications (H/A/E) and what are 4 major warnings of use (H/H/EI/G)?

Answer 12

• used in HF treatment and to manage edema associated with Hepatic/Nephrotic Syndromes

CI: hypokalemia, Addison’s disease, eplerenone use

Warnings: hyperkalemia, hypotension (worse renal function), electrolyte imbalance, GYNECOMASTIA

Question 13

What is the treatment for Pericarditis?

When should Glucocorticoids be used?

Answer 13

• NSAIDs (acute idiopathic) and with Colchicine due to viral pericarditis
• duration of treatment based upon resolution of symptoms and normalization of C-reactive protein
  • assessed at presentation and weekly thereafter

Glucocorticoids used for initial therapy of acute pericarditis ONLY in patients with contraindications to NSAIDs –> use LOWEST effective dose

Question 14

NSAID use for Pericarditis and GI Toxicity

Answer 14

• NSAIDs can lead to GI toxicity when used at high doses or for prolonged periods
• those at risk should be treated for the shortest interval and receive concomitant therapy with PPIs to help protect from toxicity

Question 15

Ibuprofen and Pericarditis

What is a contraindication to use and what are 3 warnings of use?

Answer 15

CI: active gastric or duodenal ulcer, hepatic impairment, or renal impairment

W: caution in pts with HF/HTN, caution in patients with GI tract irritation, inc. risk of renal toxicity (elderly)

avoid ibuprofen use while nursing

Question 16

Colchicine and Pericarditis

What two things is it indicated for, what is it contraindicated in, and what is its major adverse reaction?

Answer 16

Indication: gout treatment and pericarditis

CI: patients with renal/hepatic impairment or use with drugs impairing CYP3A4

AR: gastrointestinal symptoms (diarrhea, nausea, vomiting, and abdominal pain)

Question 17

Vancomycin and Endocarditis

What is its major contraindication, what are 4 adverse reactions (A/RMS/AKI/H), and how does it interact with anesthetic drugs?

Answer 17

CI: pts. with vancomycin hypersensitivity

AR: anaphylaxis, “red man syndrome”, AKI, hearing loss

DI: concomitant administration has been associated with erythema and histamine-like flushing

Question 18

Which ACE Inhibitor is used as stoke prophylaxis in pts. with Sulfa Allergies?

Answer 18

Enalapril

Question 19

What are the 5 drug families used to treat patients with Myocarditis? (A/A/B/LD/AA)

Answer 19

ACE inhibitors, Angiotensin II Receptor blockers, Beta-blockers, Loop Diuretics, Aldosterone Antagonists