Myocarditis, Endocarditis, Pericarditis

Question 1

Myocarditis meds?

Answer 1

1. ACEi/ARB early on + B blockers
2. Mineralocorticoid receptor antagonist added if LVEF < 35%
3. Diuresis as needed

Question 2

This ACEi is used for HTN, CHF, diabetic nephropathy, scleroderma

Answer 2

Captopril

Captain Scler

Question 3

These two ACEi can be used for diabetic nephropathy

Answer 3

Captopril and Enalapril

EC to eat sugar

Question 4

This ACEi is used for stroke prophylaxis

Answer 4

Enalapril

strokE

Question 5

These ACEi are used for proteinuria

Answer 5

Enalapril and Fosinopril

EF in my pee

Question 6

This ACEi is used for acute MI within 24 hours

Answer 6

Lisinopril

LIsten I got an MI

Question 7

These ACEi are used for HF, HTN

Answer 7

All of them (Benazepril is the only one who can do only these)

Question 8

Whice ACEi does have sulfa properties?

Answer 8

Captopril

Sulfa CAPsule

Question 9

Do ACEi and ARBs and B blockers have lots of drug interactions?

Answer 9

Yes

Question 10

What is the black box warning for all ACEi and ARBs?

Answer 10

Fetal death

Question 11

What are the 4 main containdications for Captopril? Which one is unique to this drug?

Answer 11

1. Sulfa allergies
2. Angioedema
3. ACEi hypersensitivity
4. Aortic stenosis = unique

Question 12

What are the 4 adverse reactions to myocarditis?

Answer 12

1. Abdominal pain
2. Agranulocytosis
3. Alopecia
4. Anaphylactoid reactions

Question 13

What are the 4 main monitoring parameters for Captopril?

Answer 13

1. BP
2. Creatinine/BUN
3. K+
4. Na+

Question 14

This ACEi is given with a thiazide to drop BP

Answer 14

Fosinopril

Falling BP = Fosinopril

Question 15

What are the specific drug-drug interactions with Lisinopril?

Answer 15

1. Diuretic Therapy: drops BP
2. Antidiabetics: drops glucose
3. NSAIDs: drop renal function

DAN

Question 16

CI for this one: prior history of angioedema related to prior ACEi and in patients with hereditary/idiopathic angioedema

Answer 16

Lisinopril

LIsten I got an MI, angioedema so be careful!

Question 17

This ARB is used for HTN in strokes and MIs, HF

Answer 17

Valsartan

Very necessary

Question 18

Indications for Losartan

Answer 18

This ARB is used to drop BP in children >6 YO, reduce stroke in HTN patients, diabetic nephropathy

Kids LOse games and listen to the strokes

Question 19

This ARB used for mild to severe HF, LV dysfunction post-MI, HTN

Answer 19

Carvedilol

Question 20

This ARB has no contraindications

Answer 20

Valsartan

Valliant Valsartan

Question 21

This ARB is not indicated in black patients, elderly patients or children

Answer 21

Losartan

Question 22

What are the 3 warnings for ARBs?

Answer 22

1. Fetal death
2. Hypotension
3. Impaired liver and kidney function

Question 23

This ARB is associated with asthenia, allergic reaction, impotence, palpitations

Answer 23

Valsartan

Valliance has it’s price: impotence, weakness and allergies

Question 24

This beta blocker is indicated for treatment of mild to severe chronic heart failure, LV dysfunction after MI, HTN

Answer 24

Carvedilol

Question 25

This beta blocker is indicated for angina, atrial fibrillation, atrial flutter, HF, HTN

Answer 25

Bisoprolol

Question 26

This beta blocker is indicated for MI, migraines, tremor, unstable angina

Answer 26

Metoprolol

Question 27

What is the warning for carvedilol?

Answer 27

Acute CAD exacerbation after stopping therapy, don't discontinue

Question 28

What is the warning for Bisoprolol?

Answer 28

Abrupt cessation of therapy

Question 29

What is the indication for furosemide?

Answer 29

Rapid onset edema associated with heart, liver, kidney, give IV for this effect

Question 30

What are the contraindications for Furosemide?

Answer 30

Anuria, furosemide hypersensitivity that leads to water/electrolyte depletion Anything that indicates you're already fluid depleted

Question 31

What are the adverse effects of furosemide?

Answer 31

Low sodium, potassium, magnesium, calcium | Hypochloremic alkalosis

Question 32

What are the drug interactions of furosemide?

Answer 32

Ototoxicity esp. if renal impairment | Don't use with ethacrynic acid

Question 33

What is the warning against spironolactone?

Answer 33

Hyperkalemia, hypotension, electrolyte abnormalities, gynecomastia

Question 34

What drug do we not give to patients with Addison's disease?

Answer 34

Spironolactone

Question 35

Drug used for HF, hepatic/nephritic syndrome, primary hyperaldosteronism

Answer 35

Spironolactone

Question 36

Management of pericarditis

Answer 36

NSAIDs + colchicine for 2 weeks or symptoms resolve then taper for 1 day. Check CRP weekly until normal then begin taper

Question 37

When are glucocorticoids used in pericarditis?

Answer 37

CI to NSAIDs, low doses pls

Question 38

What are the risks of prolonged NSAID use?

Answer 38

1. PUD 2. Age 65+ 3. Aspirin, corticosteroids, anticoagulants used at the same time That's why we give colchicine to help

Question 39

Active gastric ulcer or duodenal ulcer, GI bleed, liver issues, renal issues. What drug CI?

Answer 39

Ibuprofen

Question 40

When is colchicine indicated?

Answer 40

Gout treatment, pericarditis

Question 41

What are the contraindications to colchicine?

Answer 41

CYP3A4 drugs (drug interactions), liver or kidney issues

Question 42

How do we treat endocarditis?

Answer 42

Target to blood culture for endocarditis, accurate diagnosis is critical, therapy can await blood results most times. Vancomycin is appropriate empiric (staph, strep, entero), obtain infectious disease consult Acutely ill = empiric therapy Completing therapy = IV therapy best if hemodynamically stable first with monitoring Counsel patients that you may need repeat labs, can last 4-6 weeks

Question 43

What are the contraindications to vancomycin?

Answer 43

Hypersensitivity

Question 44

What are the 5 common adverse reactions to vancomycin?

Answer 44

Anaphylaxis, "red man syndrome", AKI, hearing loss, neutropenia

Question 45

What are the drug interactions with vancomycin?

Answer 45

Anesthetics -> erythema and flushing

Question 46

Infusion reactions, nephrotoxicity, ototoxicity, C. difficile diarrhea, neutropenia, phlebitis, and drug resistant bacteria are associated with this drug

Answer 46

Vancomycin