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CPR II Drugs test 1 > Treatment of Myocarditis, Endocarditis, and Pericarditis > Flashcards

Treatment of Myocarditis, Endocarditis, and Pericarditis Flashcards

1
Q

What is the Genaral Management of a Patient with Myocarditis?

A

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

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2
Q

what are the common ACE inhibitors used?

A
  • Benazepril
  • Captopril
  • Enalapril
  • Fosinopril
  • Lisinopril

Moexipril
Perindopril
Quinapril

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3
Q

what are the common angiotensin II receptor blockers?

A 
Azilsartan
Candesartan
Eprosartan
Irbesartan
*Losartan
Olmesartan
Telmisartan
*Valsartan
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4
Q

Indications, MOA of Benazepril?

A

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

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5
Q

Adverse reactions and contrainidictions of Benazepril

A 
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
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6
Q

what are the monitoring Parameters for Benazepril?

A 
Monitoring Parameters
•blood pressure
•serum creatinine/BUN
•serum potassium
•serum sodium
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7
Q

what is the Black Box warning for Benazepril

A

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.

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8
Q

Indications and Monitoring Parameters of Captopril

A

ACE inhibitor

Treatment of Hypertension, Congestive Heart failure, and various renal syndromes such as diabetic nephropathy and scleroderma

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9
Q

What are the Contraindications and adverse reactions of Captopril

A 
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
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10
Q

What is the Black Box warning for Captopril?

A

Fetal Toxicity

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11
Q

what are the indications and Monitoring Parameters for Enalapril

A

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)
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12
Q

What are the adverse reactions and contraindictions of Enalapril

A 
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
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13
Q

what is the black box warning for Enalapril

A

Fetal toxicity

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14
Q

Indications and monitoring parameters for Fosinopril

A

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
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15
Q

What are the Contraindications and adverse reactions of Fosinopril

A 
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
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16
Q

what are the black box warning for Fosinopril

A

Fetal Toxicity

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17
Q

What are the Indications for Lisinopril?

A

ACE inhibitor

IND: HPTN, HF for patients not responding to diuretics and digitalis, AMI for the treatment of hemodynamically stable patients within 24 hours

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18
Q

what are the 3 drug drug interactions of Lisinopril?

A

Patients on Diuretic therapy

Antidiabetics (lead to hypoglycemia)

NSAIDS (lead to destruction of renal function)

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19
Q

Contraindictions and adverse reactions, and Black box warning of Lisinopril

A

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

20
Q

Indications and Contrandictions of Valsartan?

A

Angiotensin II receptor blocker

IND: treatment of hypertension decreaseing the risk of fatal and nonfatal cardiovascular events

  • HF
  • Post MI

Contraindictions: None

21
Q

Warnings and adverse reactions of Valsartan?

A 
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

22
Q

Indications and Monitoring Parameters of Losartan

A

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)

23
Q

What are the warnings, adverse reactions and COntraindictions of Losartan

A 
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
24
Q

Carvedilol Indications and Monitoring Parameters

A

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
25
Q

What are the Warnings of Carvedilol

A

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.

26
Q

what are the contraindictions and adverse reactions of Carvedilol

A
  • 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

27
Q

What are the Indications and Monitoring Parameters of Bisoprolol

A

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
28
Q

What are the Contraindictions, Warnings, and Adverse reactions of Bisoprolol

A 
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
29
Q

what are the Indications and Monitoring parameters for Metoprolol

A

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
30
Q

What are the Contraindictations and Adverse reactions of Metoprolol

A 
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
31
Q

What are the Indications for the use of Furosemide?

A

EDEMA

indicated in adults and pediatric patients for the treatment of edema associated with CHF, cirrhosis, renal disease

IV administration, oral, paraenteral

32
Q

what are the Contraindictations and warnings of Furosemide

A

Hypersensitivity to furosemide

Warnings: Potent diuretic which excessive amounts can lead to water and electrolyte depletion

33
Q

what are the Adverse effects and drug interactions of Furosemide

A

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.

34
Q

Indications of Spironolactone?

A

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

35
Q

Contraindications and warnings and precautions of Spironolactone

A

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)

36
Q

what are the drug interactions of Spironolactone

A

DRUG INTERACTIONS
•Agents ^serum K+»Hyperkalemia
•Lithium: ^Li toxicity
•NSAIDs reduces effect of Aldosterone

37
Q

How to treat Pericarditis?

A

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.

38
Q

when should glucocorticoids be used in the treatment of Pericarditis?

A

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.

39
Q

what is a major side effect of NSAID treatment?

A

Gastrointestinal toxicity

important to co administer PPIs or even Colchine

40
Q

what are the List of NSAIDS?

A
  • Aspirin
  • Ketorolac,
  • Indomethacin
  • Ibuprofen
  • Flurbiprofen
  • Naproxen
  • Diclofenac
  • Celecoxib
  • Meloxicam
41
Q

what are the Contraindictions and warnings for Ibprofen

A

COntraindictions:
-Active or duodenal ulcer

Warnings:

  • HF, Hypertension patients
  • GI irritation
  • Increased renal toxicity
42
Q

What are the adverse effects of Ibuprofen?

A

Decreased appetite
Edema
Fluid retention

43
Q

What are the Indications of Colchicine and its drug interactions?

A

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

44
Q

what are the warnings, contraindications and adverse reactions of Colchicine?

A

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

45
Q

what are the general considerations when treating an Endocarditis

A

Bactericidial agents

  • target the organism
  • blood cutures are essential before using an empirical treatment
46
Q

Indications of Vancomyocin and contraindictions

A 
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

47
Q

Adverse effects, warnings, and drug interactions with vancomyocin

A

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.

CPR II Drugs test 1 (8 decks)

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