Cardio: Drugs for Myocarditis, Endocarditis, and Pericarditis

Question 1

Suffix of all ACEi?

Answer 1

-pril

Question 2

Suffix of all ARBs?

Answer 2

-sartan

Question 3

Black box warning of all ACEi and ARBs?

Answer 3

Embryotoxic!

-do not give if pt pregnant or if breastfeeding

Question 4

What should you monitor for all ACEi?

Answer 4

1. Blood pressure: check for decrease
2. Serum Creatinine/BUN: can cause early rise
3. Serum K+: can increase
4. Serum Na+: can decrease

Question 5

Adverse reactions to ACEi?

Answer 5

Alopecia, angioedema, angina, anaphylactoid reactions

Question 6

Contraindications to ACEi?

Answer 6

Angioedema, Aortic stenosis, Black patients may tolerate worse

Question 7

What can all ACEi be used to treat?

Answer 7

Heart failure and HTN

Question 8

Which of the ACEi have a sulfa allergy associated with them?

Answer 8

Captopril

Question 9

Which of the ACEi would you prescribe in someone for stroke prophylaxis?

Answer 9

Enalapril

Question 10

Which of the ACEi drugs be used in renal syndromes, such as proteinuria and diabetic neuropathy?

Answer 10

captopril, enapril, fosinopril

Question 11

Fosinopril is used in combo with what drug to increase efficacy?

Answer 11

Thiazide diuretics

-ie Hydrochlorothiazide

Question 12

Which ACEi is given post-MI to reduce mortality?

Answer 12

Lisinopril

Question 13

When prescribing lisinopril, what drug-drug interactions should you watch out for?

Answer 13

Diuretics
-can drastically reduce BP

Anti-diabetics
-can increase glucose lowering, causing hypoglycemia

NSAIDs
-combo can cause AKI

Question 14

Indications for ARBs?

Answer 14

HTN

-lowering BP reduces CV events like strokes and MI

Question 15

Which of the ARBs is used in children?

Answer 15

Losartan

-can be used to lower BP in children as young as 6yo

Question 16

Adverse effects of all ARBs?

Answer 16

Hypotension, impaired renal fxn, impaired hepatic fxn

Question 17

What should you monitor when prescribing an ARB?

Answer 17

BP,
LFTs
Serum Bilirubin

Question 18

MOA of Carvedilol?

Answer 18

Mixed a1 and non-selective B-blocker

Question 19

Indications for all B-Blockers?

Answer 19

Heart Failure,
HTN
Left ventricular dysfunction in stable pts

Question 20

Which B-blockers could you give for A-fib and A-flutter?

Answer 20

Bisoprolol and Metoprolol

-probably others, but this is what he lists

Question 21

Which B-blocker can you give for unstable angina?

Answer 21

Metoprolol

Question 22

When taking a patient off a B-Blocker, what is important to remember?

Answer 22

Taper them off

-abrupt cessation can exacerbate CAD

Question 23

Would you give a B-blocker in someone with Asthma, COPD or bronchospasm?

Answer 23

NOPE

-the cardioselective ones would be your best bet if you HAD to use a B-blocker though

Question 24

What would you monitor when giving a B-blocker?

Answer 24

BP, HR

Serum creatinine/BUN (bisoprolol)

Question 25

Which of the B-blockers can cause HF and LV dyfunction following MI?

Answer 25

Carvedilol Also look out for hyperglycemia, asthenia, and bradycardia

Question 26

Which drugs would you give for edema?

Answer 26

Furosemide (very effective!) and Spironolactone

Question 27

What do you need to watch out for when giving furosemide?

Answer 27

Water/electrolyte depletion | -so look for signs of dehydration, hypotension, hypocalemia, hyponatremia!, muscle cramps, etc

Question 28

Furosemide and aminoglycosides can cause what?

Answer 28

Ototoxicity, especially in those with renal impairment

Question 29

Would you give furosemide with ethacrynic acid?

Answer 29

Nah fam, can cause ototoxicity | -both do the same thing anyway

Question 30

MOA of spironolactone?

Answer 30

Aldosterone antagonist

Question 31

MOA of furosamide?

Answer 31

Inhibits NKCC2 transporter

Question 32

Indications for Spironolactone?

Answer 32

HF, edema, HTN, Primary hyperaldosteronism

Question 33

What do you need to look out for when prescribing spironolactone?

Answer 33

Hyperkalemia (peaked T waves??) Hypotension/worsening renal fxn Electrolyte disturbances Gynecomastia

Question 34

A 55yo male comes into your office complaining of impoetence and "growing boobs" after taking a drug for his ascites due to cirrhosis. What drug is he taking?

Answer 34

Spironolactone | -aldosterone inhibitor that isn't specific, so inhibits testosterone as well

Question 35

What drugs does spironolactone interact with?

Answer 35

Lithium (toxicity) NSAIDs reduce effect of aldosterone --increases K+ more?

Question 36

When would you se Glucocorticoids for pericarditis?

Answer 36

If contra to NSAIDs

Question 37

What should you be considerate of when giving NSAIDs?

Answer 37

Active bleeds, Ulcers, and gastritis, especially in elderly NSAIDs would be contraindicated if any of these present!

Question 38

Warnings when prescribing NSAIDs?

Answer 38

HF, HTN GI irritation Renal toxicity, especially if on diuretics

Question 39

What is first line in treating pericarditis?

Answer 39

Indomethacin and Colchicine | -from Selby

Question 40

What is the label and off label use of Colchicine?

Answer 40

Label: gout Off: pericarditis

Question 41

What drug-drug interactions should you be mindful of with colchicine?

Answer 41

those that interact w CYP3A4

Question 42

Would you prescribe colchicine in those with renal/hepatic impairment?

Answer 42

NO

Question 43

Adverse effects of colchicine?

Answer 43

GI Upset (diarrhea, N/V)

Question 44

If a patient has signs and symptoms of infectious endocarditis, what should you treat with?

Answer 44

Vancomycin until you find out the specific bug

Question 45

How long does it take to treat infectious endocarditis?

Answer 45

4-6 weeks

Question 46

Adverse reactions to vancomycin?

Answer 46

Anaphylaxis, "red man" syndrome, AKI, hearing loss, neutropenia Watch out for infusion reactions (phlebitis), ototoxicity and C. diff