Myocarditis, Endocarditis, Pericarditis Flashcards
Myocarditis meds?
- ACEi/ARB early on + B blockers
- Mineralocorticoid receptor antagonist added if LVEF < 35%
- Diuresis as needed
This ACEi is used for HTN, CHF, diabetic nephropathy, scleroderma
Captopril
Captain Scler
These two ACEi can be used for diabetic nephropathy
Captopril and Enalapril
EC to eat sugar
This ACEi is used for stroke prophylaxis
Enalapril
strokE
These ACEi are used for proteinuria
Enalapril and Fosinopril
EF in my pee
This ACEi is used for acute MI within 24 hours
Lisinopril
LIsten I got an MI
These ACEi are used for HF, HTN
All of them (Benazepril is the only one who can do only these)
Whice ACEi does have sulfa properties?
Captopril
Sulfa CAPsule
Do ACEi and ARBs and B blockers have lots of drug interactions?
Yes
What is the black box warning for all ACEi and ARBs?
Fetal death
What are the 4 main containdications for Captopril? Which one is unique to this drug?
- Sulfa allergies
- Angioedema
- ACEi hypersensitivity
- Aortic stenosis = unique
What are the 4 adverse reactions to myocarditis?
- Abdominal pain
- Agranulocytosis
- Alopecia
- Anaphylactoid reactions
What are the 4 main monitoring parameters for Captopril?
- BP
- Creatinine/BUN
- K+
- Na+
This ACEi is given with a thiazide to drop BP
Fosinopril
Falling BP = Fosinopril
What are the specific drug-drug interactions with Lisinopril?
- Diuretic Therapy: drops BP
- Antidiabetics: drops glucose
- NSAIDs: drop renal function
DAN
CI for this one: prior history of angioedema related to prior ACEi and in patients with hereditary/idiopathic angioedema
Lisinopril
LIsten I got an MI, angioedema so be careful!
This ARB is used for HTN in strokes and MIs, HF
Valsartan
Very necessary
Indications for Losartan
This ARB is used to drop BP in children >6 YO, reduce stroke in HTN patients, diabetic nephropathy
Kids LOse games and listen to the strokes
This ARB used for mild to severe HF, LV dysfunction post-MI, HTN
Carvedilol
This ARB has no contraindications
Valsartan
Valliant Valsartan
This ARB is not indicated in black patients, elderly patients or children
Losartan
What are the 3 warnings for ARBs?
- Fetal death
- Hypotension
- Impaired liver and kidney function
This ARB is associated with asthenia, allergic reaction, impotence, palpitations
Valsartan
Valliance has it’s price: impotence, weakness and allergies
This beta blocker is indicated for treatment of mild to severe chronic heart failure, LV dysfunction after MI, HTN
Carvedilol
This beta blocker is indicated for angina, atrial fibrillation, atrial flutter, HF, HTN
Bisoprolol
This beta blocker is indicated for MI, migraines, tremor, unstable angina
Metoprolol
What is the warning for carvedilol?
Acute CAD exacerbation after stopping therapy, don’t discontinue
What is the warning for Bisoprolol?
Abrupt cessation of therapy
What is the indication for furosemide?
Rapid onset edema associated with heart, liver, kidney, give IV for this effect
What are the contraindications for Furosemide?
Anuria, furosemide hypersensitivity that leads to water/electrolyte depletion
Anything that indicates you’re already fluid depleted
What are the adverse effects of furosemide?
Low sodium, potassium, magnesium, calcium
Hypochloremic alkalosis
What are the drug interactions of furosemide?
Ototoxicity esp. if renal impairment
Don’t use with ethacrynic acid
What is the warning against spironolactone?
Hyperkalemia, hypotension, electrolyte abnormalities, gynecomastia
What drug do we not give to patients with Addison’s disease?
Spironolactone
Drug used for HF, hepatic/nephritic syndrome, primary hyperaldosteronism
Spironolactone
Management of pericarditis
NSAIDs + colchicine for 2 weeks or symptoms resolve then taper for 1 day. Check CRP weekly until normal then begin taper
When are glucocorticoids used in pericarditis?
CI to NSAIDs, low doses pls
What are the risks of prolonged NSAID use?
- PUD
- Age 65+
- Aspirin, corticosteroids, anticoagulants used at the same time
That’s why we give colchicine to help
Active gastric ulcer or duodenal ulcer, GI bleed, liver issues, renal issues. What drug CI?
Ibuprofen
When is colchicine indicated?
Gout treatment, pericarditis
What are the contraindications to colchicine?
CYP3A4 drugs (drug interactions), liver or kidney issues
How do we treat endocarditis?
Target to blood culture for endocarditis, accurate diagnosis is critical, therapy can await blood results most times. Vancomycin is appropriate empiric (staph, strep, entero), obtain infectious disease consult
Acutely ill = empiric therapy
Completing therapy = IV therapy best if hemodynamically stable first with monitoring
Counsel patients that you may need repeat labs, can last 4-6 weeks
What are the contraindications to vancomycin?
Hypersensitivity
What are the 5 common adverse reactions to vancomycin?
Anaphylaxis, “red man syndrome”, AKI, hearing loss, neutropenia
What are the drug interactions with vancomycin?
Anesthetics -> erythema and flushing
Infusion reactions, nephrotoxicity, ototoxicity, C. difficile diarrhea, neutropenia, phlebitis, and drug resistant bacteria are associated with this drug
Vancomycin
