Treatment of Myocarditis, Endocarditis, and Pericarditis Flashcards
What is the Genaral Management of a Patient with Myocarditis?
Treatment of Hemodynamically stable HF with reduced ejection fraction includes diuresis
ACE inhibitor (or ARB)
Beta-Blockers therapy is decreased or withheld in patients with more than mild acute decompensated HF
what are the common ACE inhibitors used?
- Benazepril
- Captopril
- Enalapril
- Fosinopril
- Lisinopril
Moexipril
Perindopril
Quinapril
what are the common angiotensin II receptor blockers?
Azilsartan Candesartan Eprosartan Irbesartan *Losartan Olmesartan Telmisartan *Valsartan
Indications, MOA of Benazepril?
Management of Hypertension and the treatment of Heart failure (reduced ejection fraction)
Does not contain a sulfa group
Competes with ACE for the substate angiotensin ! and therby blocking it from turning to angiotensin II
Adverse reactions and contrainidictions of Benazepril
Adverse Reactions •alopecia •anaphylactoid reactions •angina •angioedema •Anxiety…many more
Contraindications •ACE-inhibitor induced angioedema •agranulocytosis •Angiotensin-converting enzyme inhibitors (ACE inhibitors) hypersensitivity •aortic stenosis •Black patients •bone marrow suppression •breast-feeding •cardiomyopathy •cerebrovascular disease •children
what are the monitoring Parameters for Benazepril?
Monitoring Parameters •blood pressure •serum creatinine/BUN •serum potassium •serum sodium
what is the Black Box warning for Benazepril
Black Box Warning: Fetal Toxicity-When pregnancy is detected, discontinue ASAP. Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.
Indications and Monitoring Parameters of Captopril
ACE inhibitor
Treatment of Hypertension, Congestive Heart failure, and various renal syndromes such as diabetic nephropathy and scleroderma
What are the Contraindications and adverse reactions of Captopril
Contraindications •Sulphur allergy** •ACE-inhibitor induced angioedema •angioedema •Angiotensin-converting enzyme inhibitors (ACE inhibitors) hypersensitivity •aortic stenosis •autoimmune disease
Adverse Reactions •abdominal pain •agranulocytosis •alopecia •anaphylactoid reactions angiodema
What is the Black Box warning for Captopril?
Fetal Toxicity
what are the indications and Monitoring Parameters for Enalapril
ACE inhibitors
Used in the treatment of diabetic neuropathy, HF, HPTN, proteinuria, and stroke prophylaxis
Monitoring Parameters:
- Blood pressure
- LFTs
- Serium billirubin (total and diirect)
What are the adverse reactions and contraindictions of Enalapril
Adverse Reactions •abdominal pain •alopecia •anaphylactoid reactions •anemia •angina •angioedema •anorexia •anxiety •arrhythmia exacerbation
Contraindications •ACE-inhibitor induced angioedema •angioedema •Black patients •breast-feeding •children •geriatric •heart failure •hepatic disease •hyperkalemia
what is the black box warning for Enalapril
Fetal toxicity
Indications and monitoring parameters for Fosinopril
IND: treatment of HF, HTPN, Proteinuria
used with thiazide gives greater blood pressure lowering effect
Monitoring Parameters •blood pressure •serum creatinine/BUN •serum potassium •serum sodium
What are the Contraindications and adverse reactions of Fosinopril
Contraindications •ACE-inhibitor induced angioedema •angioedema •Angiotensin-converting enzyme inhibitors (ACE inhibitors) hypersensitivity •aortic stenosis •autoimmune disease •Black patients •bone marrow suppression •breast-feeding •cardiomyopathy •cerebrovascular disease •Etc…
Adverse Effects •abdominal pain •agranulocytosis •anaphylactoid reactions •anemia •angina •angioedema •arthralgia •azotemia •bradycardia •bronchospasm
what are the black box warning for Fosinopril
Fetal Toxicity
What are the Indications for Lisinopril?
ACE inhibitor
IND: HPTN, HF for patients not responding to diuretics and digitalis, AMI for the treatment of hemodynamically stable patients within 24 hours
what are the 3 drug drug interactions of Lisinopril?
Patients on Diuretic therapy
Antidiabetics (lead to hypoglycemia)
NSAIDS (lead to destruction of renal function)
Contraindictions and adverse reactions, and Black box warning of Lisinopril
CONTRAINDICATIONS: Patients who are hypersensitive to this product and in patients with a history of angioedema related to previous treatment with an angiotensin converting enzyme inhibitor and in patients with hereditary or idiopathic angioedema.
Adverse Reactions •alopecia •anaphylactoid reactions •anemia •angioedema •arthralgia •asthenia •azotemia •blurred vision
BB: Feftal toxicity
Indications and Contrandictions of Valsartan?
Angiotensin II receptor blocker
IND: treatment of hypertension decreaseing the risk of fatal and nonfatal cardiovascular events
- HF
- Post MI
Contraindictions: None
Warnings and adverse reactions of Valsartan?
Warning/Precautions •Fetal/Neonatal Morbidity and Mortality (BB) •Hypotension •Impaired Hepatic Function •Impaired Renal Function
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
Indications and Monitoring Parameters of Losartan
Angiotensin II receptor Blocker
Treatment of Hypertension in adults and children over 6
-reduce risk of stroke
Treatment of diabetic neuropathy with and elevated serum creatinine and proteinuria in patients who are type 2 diabetics
Monitoring Parameters:
•blood pressure
•LFTs
•serum bilirubin (total and direct)
What are the warnings, adverse reactions and COntraindictions of Losartan
Warning/Precautions •Fetal/Neonatal Morbidity and Mortality (BB) •Hypotension •Impaired Hepatic Function •Impaired Renal Function
Adverse Reactions •abdominal pain •alopecia •anaphylactoid reactions •anemia •angina •angioedema •anorexia •anxiety •arrhythmia exacerbation
Contraindictions: •ACE-inhibitor induced angioedema •angioedema •Black patients •breast-feeding •children •geriatric •heart failure •hepatic disease •hyperkalemia •hypotension •hypovolemia
Carvedilol Indications and Monitoring Parameters
Beta blocker that is a alpha and nonselective beta blocker
IND: Treatment of Chronic Heart failure, LV dysfunction following an MI in a stable patient, Hypertension
Monitoring Parameters:
- BLood pressure
- Heart rate
What are the Warnings of Carvedilol
Warnings
•Acute exacerbation of coronary artery disease upon cessation of therapy; donot abruptly discontinue.
•
Bradycardia, hypotension, worsening heart failure/fluid retention may occur. Reduce dose as needed.
•
Non-allergic bronchospasm (e.g.chronic bronchitis and emphysema):Avoidβ-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 are the contraindictions and adverse reactions of Carvedilol
- 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
Adverse Reactions:
•Heart failure and LV dysfunction following myocardial infarction (≥10%): Dizziness, fatigue, hypotension, diarrhea, hyperglycemia, asthenia, bradycardia, weight increase
•Hypertension (≥5%): Dizziness
What are the Indications and Monitoring Parameters of Bisoprolol
Beta1-selective adrenoceptor blocking agent
IND: used in the treatment for angina, atrial fibrillation, atrial flutter, HF, and HPTN
Monitoring Parameters:
- Blood pressure
- Heart rate
- Serium createnine and BUN
What are the Contraindictions, Warnings, and Adverse reactions of Bisoprolol
Contraindications •abrupt discontinuation •acute bronchospasm •acute heart failure •asthma
Warnings:
•Cardiac Failure
•In Patients Without a History of Cardiac Failure
•Abrupt Cessation of Therapy
Adverse Reactions •acne vulgaris •alopecia •angina •angioedema •arthralgia •asthenia •AV block •back pain •bradycardia •bronchospasm •chest pain (unspecified) •cough •depression
what are the Indications and Monitoring parameters for Metoprolol
Metoprolol is a competitive beta 1 selective cardioselective adrenergic antagonist
IND:•acute myocardial infarction •angina •atrial fibrillation •atrial flutter •cardiomyopathy •heart failure •hypertension •migraine prophylaxis •reduction of cardiovascular mortality •tremor •unstable angina
Monitoring Parameters:
- BP
- HR
What are the Contraindictations and Adverse reactions of Metoprolol
Contraindications •abrupt discontinuation •acute bronchospasm •acute heart failure •asthma •AV block •beta-blocker hypersensitivity •bradycardia •breast-feeding •bronchitis •cardiogenic shock •cerebrovascular disease
Adverse reactions: -abdominal pain •agranulocytosis •alopecia •amnesia •anxiety •arthralgia •AV block •blurred vision
What are the Indications for the use of Furosemide?
EDEMA
indicated in adults and pediatric patients for the treatment of edema associated with CHF, cirrhosis, renal disease
IV administration, oral, paraenteral
what are the Contraindictations and warnings of Furosemide
Hypersensitivity to furosemide
Warnings: Potent diuretic which excessive amounts can lead to water and electrolyte depletion
what are the Adverse effects and drug interactions of Furosemide
All patients receiving furosemide therapy should be observed for these signs or symptoms of fluid or electrolyte imbalance (hyponatremia, hypochloremicalkalosis, hypokalemia, hypomagnesemia or hypocalcemia)
Dryness of mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pains or cramps, muscular fatigue, hypotension, oliguria, tachycardia, arrhythmia, or GI disturbances such as N/V
Furosemide may increase the ototoxic potential of aminoglycoside antibiotics, especially in the presence of impaired renal function. Except in life-threatening situations, avoid this combination. Furosemide should not be used concomitantly with ethacrynic acid because of the possibility of ototoxicity.
Indications of Spironolactone?
aldosterone antagonist and acts as a Aldosterone Receptor Blocker
Indications:
•Used in the treatment of HF, reduced ejection fraction to increase survival
•Manage edema
•Reduce the need for hospitalization for HF
•HPTN
•Edema assoc. with Hepatic/Nephrotic Syndrome
•Primary Hyperaldosteronism
Contraindications and warnings and precautions of Spironolactone
Contraindications:
•Hypokalemia
•Addison’s Disease
•Concomitant use of Eplerenone
WARNINGS AND PRECAUTIONS
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 are the drug interactions of Spironolactone
DRUG INTERACTIONS
•Agents ^serum K+»Hyperkalemia
•Lithium: ^Li toxicity
•NSAIDs reduces effect of Aldosterone
How to treat Pericarditis?
Nonsteroidal and Anti-Inflammatory Drugs (NSAIDs) for nearly all patients with acute idiopathic or
viral pericarditis in combination with Colchicine
Duration of treatment is based upon the resolution of symptoms and normalization of C-reactive protein (CRP). In this approach, CRP is assessed at presentation and then weekly, using the anti-inflammatory dose of NSAIDs until complete resolution of symptoms (for at least 24 hours) and normalization of CRP, at which point tapering begins.
when should glucocorticoids be used in the treatment of Pericarditis?
Glucocorticoids should be used for initial treatment of acute pericarditis only in patients with contraindications to NSAIDs, or for specific indications (ie, systemic inflammatory diseases, pregnancy, and possibly renal failure), and should be used at the lowest effective dose.
what is a major side effect of NSAID treatment?
Gastrointestinal toxicity
important to co administer PPIs or even Colchine
what are the List of NSAIDS?
- Aspirin
- Ketorolac,
- Indomethacin
- Ibuprofen
- Flurbiprofen
- Naproxen
- Diclofenac
- Celecoxib
- Meloxicam
what are the Contraindictions and warnings for Ibprofen
COntraindictions:
-Active or duodenal ulcer
Warnings:
- HF, Hypertension patients
- GI irritation
- Increased renal toxicity
What are the adverse effects of Ibuprofen?
Decreased appetite
Edema
Fluid retention
What are the Indications of Colchicine and its drug interactions?
IND:
Gout treatment (acute flares)
-Pericarditis, acute or recurrent (treatment) (off-label use) Patients with acute idiopathic or viral pericarditis
Drug interactions:
Co-administration of CYP3A4 inhibitors
what are the warnings, contraindications and adverse reactions of Colchicine?
CONTRAINDICATIONS:
•Patients with renal or hepatic impairment
•Drugs that inhibit both CYP3A4
•Patients with both renal and hepatic impairment
ADVERSE REACTIONS:
The most commonly reported adverse reactions with colchicine are gastrointestinal symptoms, including diarrhea, nausea, vomiting, and abdominal pain
WARNINGS AND PRECAUTIONS:
Monitor for toxicity and, if present, consider lowering the dose,
temporary interruption or discontinuation of colchicine
what are the general considerations when treating an Endocarditis
Bactericidial agents
- target the organism
- blood cutures are essential before using an empirical treatment
Indications of Vancomyocin and contraindictions
INDICATIONS: For adult and pediatric patients (neonates and older) for the treatment of : • Septicemia • Infective Endocarditis • Skin and Skin Structure Infections • Bone Infections • Lower Respiratory Tract Infections
CONTRAINDICATIONS:
Hypersensitivity to vancomycin
Adverse effects, warnings, and drug interactions with vancomyocin
The common adverse reactions are anaphylaxis, “red man syndrome”, acute kidney Injury, hearing loss, neutropenia
Warnings & Precautions: •Infusion Reactions •Nephrotoxicity •Ototoxicity •C. Difficile associated diarrhea •Neutropenia •Phlebitis •Development of drug-resistant bacteria
Drug interactions:
• Anesthetic Agents: Concomitant administration of vancomycin and anesthetic agents has been associated with erythema and histamine-like flushing.
