Pericarditis Flashcards
ibuprofen dose
600-800 mg po q8h
aspirin dose
650-1000 mg po q8h
indomethacin dose
25-50 mg po q8h
ketorolac dose
15-30 mg IV/IM q6h
duration of NSAID therapy
until symptom resolution followed by 2-4 weeks tapering
when is aspirin preferred
MI-associated pericarditis
when is ketorolac preferred
it’s an alternative NSAID for NPO or severe pain
maximum duration of therapy for ketorolac
5 days due to negative renal and cardiac effects
NSAID side effects
GI toxicity (ulcer, gastritis), bleeding, consider addition of omeprazole
colchicine dose
0.6 mg po bid (once daily if older than 70 or weigh less than 70 kg)
colchicine adverse effects
diarrhea, nausea, vomiting
duration of therapy for colchicine
3 months for first pericarditis episode, 6 months if recurrent
when is colchicine dose adjusted
renal, older than 70, weigh less than 70 kg
prednisone dose
0.2-0.5 mg/kg po daily with a taper schedule
when is prednisone used
ONLY for patients who failed first line therapy or have a contraindication to aspirin/NSAID therapy
anakinra dose
1-2 mg/kg sq daily (max 100 mg daily)
anakinra adverse effects
infection, injection reaction, antibody development, neutropenia
rilonacept dose
320 mg once sq then 160 mg sq weekly
rilonacept adverse reactions
infection, URI, injection reaction, antibody development
when are IL-1 blockers used
there is data for their use in recurrent pericarditis
azathioprine dose
1 mg/kg/day po (max 3 mg/kg/day)
methotrexate dose
10-15 mg po weekly
mycophenolate dose
1000 mg po bid
IVIG dose
400-500 mg/kg/day IV, daily x 5 days for one cycle
drugs causing pericarditis
dantrolene, doxorubicin, hydralazine, isoniazid, immune checkpoint inhibitors, methysergide, pergolide, phenylbutazone, phenytoin, procainamide
symptoms of pericarditis
chest pain is sharp, rapid onset, clear relationship to breath inspiration/coughing/hiccups, relieved when sitting up or leaning forward
physical exam findings for pericarditis
sinus tachycardia, fever, pericardial rub audible on left sternal border
ECG findings for pericarditis
PR segment depression with ST segment elevation
lab findings for pericarditis
troponin may be positive, inflammatory markers are WBC, ESR, CRP
diagnosis of pericarditis
must meet 2 of 4 following criteria: chest pain, pericardial rub PR segment depression w/ ST segment elevation, new or worsening pericardial effusion
acute pericarditis
<4-6 weeks
incessant pericardititis
> 4-6 weeks without remission
recurrent pericardititis
new signs and symptoms after a symptom free period of 4-6 weeks
chronic pericarditis
> 3 months
pericarditis complications
pericardial effusion, constrictive pericarditis, cardiac tamponade
when hospital admission is required
fever >38 C (100.4 F), subacute onset, large pericardial effusion, cardiac tamponade, lack of response to initial therapy for at least a week, myopericarditis, immunosuppression, trauma, oral anticoagulant therapy
prednisone tapering if dose >50 mg
taper 10 mg/day every 1-2 weeks
prednisone tapering if dose 25-50 mg
taper 5 mg/day every 1-2 weeks
prednisone tapering if dose 15-25 mg
taper 2.5 mg/day every 1-2 weeks
prednisone tapering if dose <15 mg
taper 1.25 mg/day every 1-2 weeks
