Drugs to Treat Endocarditis, Myocarditis, and Pericarditis

Question 1

What are the classes of drugs used to treat myocarditis?

Answer 1

1) ACE inhibitors
2) Angiotensin II receptor blockers
3) Beta blockers
4) Diuretics
5) Aldosterone-Receptor blocker

Question 2

What ACE inhibitors are used to treat myocarditis?

Answer 2

-pril:

1) Benazepril
2) Captopril
3) Enalapril
4) Fosinopril
5) Lisinopril

Question 3

What Angiotensin II receptor blockers used to treat myocarditis?

Answer 3

-artan:

1) Losartan
2) Valsartan

Question 4

In the treatment of myocarditis, what is benazepril indicated for?

Answer 4

Management of HTN and Tx of heart failure

Question 5

What does benazepril not contain which makes it different from other ACE inhibitors with regard to safety profile?

Answer 5

Sulfhydryl group

Question 6

What population is benazepril contraindicated for?

Why?

Answer 6

1) Black patients

2) Cause angioedema

Question 7

Captopril similarly to benazepril is indicated for treatment of HTN and congestive heart failure but also?

Answer 7

Diabetic neuropathy and scleroderma

Question 8

What contraindication is common with captopril?

What should be used instead?

Answer 8

1) Sulphur allergy

2) Benazepril, enalapril, or fosinopril

Question 9

Besides being used for the treatment of myocarditis, enalapril is indicated for?

Answer 9

Stroke prophylaxis

Question 10

Fosinopril similarly to the other ACE inhibitors is indicated for treatment of HTN and heart failure but also?

Answer 10

Proteinuria

Question 11

Fosinopril in combination with what other drug gives a blood pressure lowering effect greater than that seen with either agent alone?

Answer 11

Thiazide diuretics

Question 12

Lisinopril similarly to the other ACE inhibitors is indicated for treatment of HTN and heart failure but also?

Answer 12

Acute MI

Question 13

What drug-drug interaction is seen with lisinopril and patients on diuretic therapy?

Answer 13

Hypotension

Question 14

What drug-drug interaction is seen with lisinopril and patients on antidiabetics?

Answer 14

Hypoglycemia

Question 15

What drug-drug interaction is seen with lisinopril and patients on NSAIDs?

Answer 15

Damage renal function

Question 16

What black box warning is associated with the ACE inhibitors?

Answer 16

Fetal toxicity

Question 17

What contraindication is seen with the ACE inhibitors?

Answer 17

Angioedema

Question 18

What parameters do you want to monitor when administering ACE-inhibitors?

Answer 18

1) BP
2) Creatinine/BUN
3) Potassium
4) Sodium

Question 19

What is Valsartan indicated for?

Answer 19

Treatment of HTN, heart failure, and post MI

Question 20

What is Losartan indicated for?

Answer 20

1) Treatment of HTN in adults and children greater than 6
2) Reduce risk of stroke
3) Treatment of diabetic nephropathy

Question 21

What black box warning do the Angiotensin II Receptor Blockers have?

Answer 21

Fetal toxicity

Question 22

What warnings/precautions are associated with Angiotensin II Receptor Blockers?

Answer 22

1) Hypotension
2) Impaired hepatic function
3) Impaired renal function

Question 23

What beta blockers are used in the treatment of myocarditis?

Answer 23

1) Carvedilol
2) Bisoprolol
3) Metoprolol

Question 24

What receptors does carvedilol block?

Answer 24

Alpha-and nonselective beta-blocker

Question 25

What receptor does Bisoprolol block?

Answer 25

Beta-1

Question 26

What receptor does Metoprolol block?

Answer 26

Beta-1

Question 27

What warning is associated with beta blockers?

Answer 27

Avoid abrupt cessation of therapy

Question 28

What contraindication is seen with beta blockers?

Answer 28

Bronchospasm and asthma

Question 29

What diuretic used to treat myocarditis?

Answer 29

Furosemide

Question 30

What is furosemide indicated for?

Answer 30

Treatment of edema associated with CHF

Question 31

What warning is associated with furosemide?

Answer 31

Profound diuresis can cause water/electrolyte depletion

Question 32

When should parenteral furosemide be replaced with oral furosemide?

Answer 32

As soon as practical

Question 33

What drug-drug interaction does furosemide commonly have? This may increase the potential of? Especially in the presence of?

Answer 33

1) Aminoglycoside antibiotics 2) Ototoxicity 3) Impaired renal function

Question 34

Furosemide should also not be used concomitantly with what drug due to possibility of ototoxicity?

Answer 34

Ethacrynic acid

Question 35

What aldosterone antagonist is used to treat myocarditis?

Answer 35

Spironolactone

Question 36

What warnings/precautions are associated with spironolactone?

Answer 36

1) Hyperkalemia | 2) Gynecomastia

Question 37

What used as management for acute idiopathic or viral pericarditis?

Answer 37

NSAIDS in combination with colchicine

Question 38

The duration of treatment of pericarditis is based upon?

Answer 38

1) Resolution of symptoms | 2) Normalization of CRP

Question 39

What should be used for initial treatment of acute pericarditis only in patients with contraindications to NSAIDs?

Answer 39

Glucocorticoids

Question 40

What contraindication is associated with ibuprofen?

Answer 40

Active gastric or duodenal ulcer

Question 41

What drug interactions are seen with colchicine?

Answer 41

CYP3A4 inhibitors

Question 42

What are necessary for effective treatment of endocarditis?

Answer 42

Bactericidal agents

Question 43

What is the critical first step in designing a management strategy for endocarditis?

Answer 43

Accurate diagnosis from blood cultures

Question 44

Empiric antibiotics should cover?

Answer 44

1) Staphylococci 2) Streptococci 3) Enterococci

Question 45

What is a reasonable initial therapy for endocarditis?

Answer 45

Vancomycin

Question 46

Concomitant administration of vancomycin and anesthetic agents has been associated with?

Answer 46

Erythema and histamine-like flushing