Pleural Effusions: Causes and Medications

Pneumonia, heart failure (HF), lung cancer, and inflammatory disorders can all cause pleural effusions.

Furosemide (a loop diuretic), Zosyn and gentamicin (antibiotics), nitroglycerin (a vasodilator), chemotherapy, and sclerosing agents are some medications used to treat pleural effusions.

Zosyn is a broad-spectrum penicillin antibiotic used to treat pleural effusions and empyema. It can cause diarrhea and is contraindicated in patients with renal problems or penicillin allergies.

Gentamicin is a potent aminoglycoside antibiotic used to treat pleural effusions. It can cause nephrotoxicity and ototoxicity. Monitor peak and trough levels to ensure safe and effective treatment.

Furosemide and bumetanide are loop diuretics that work at the loop of Henle to promote diuresis. They can cause dehydration, hypotension, hypokalemia, ototoxicity, and kidney injury. Administer slowly to prevent ototoxicity.

PT/INR is monitored for Warfarin, while aPTT and Anti-Xa are monitored for Heparin.

Heparin, given intravenously or subcutaneously, binds to activated clotting factors, activating antithrombin to inactivate Factor Xa and stop the clotting cascade. It can cause toxicity (protamine sulfate), bleeding, and kidney problems. Monitor aPTT, Anti-Xa, and kidney function.

Low-molecular-weight heparin (LMWH), such as enoxaparin and dalteparin, given subcutaneously, activates antithrombin to inactivate Factor Xa, stopping the clotting cascade. It can cause bleeding and thrombocytopenia. Protamine sulfate (1:1) can reverse its effects. Bleeding precautions are highly recommended.

Warfarin (Coumadin), a medication taken orally, inhibits vitamin K synthesis, which in turn inhibits the production of clotting factors II, VII, IX, and X. It's monitored using PT/INR and liver enzymes. It has a long half-life and is impacted by consumption of leafy green vegetables.

Heparin is administered for rapid onset of action, while warfarin is started concurrently to achieve therapeutic levels. Heparin is discontinued when warfarin reaches its therapeutic range.

Fondaparinux (Arixtra) is a medication given subcutaneously that specifically inhibits Factor Xa, preventing thrombosis. It's used for PE and DVT. It's contraindicated in patients with kidney disease and low creatinine clearance.

Alteplase and tPA are thrombolytics, given intravenously, that activate the conversion of plasminogen to plasmin, which dissolves blood clots. Mimicking the body's natural process of breaking down clots. They are used for patients experiencing a STEMI within 12 hours of symptom onset and are associated with significant bleeding risk. Monitor for bleeding.

A normal aPTT in a person not taking Heparin is 25-35 seconds. When on Heparin, it should be 40-90 seconds.

Short-acting beta agonists (SABAs), like albuterol, stimulate the Beta-2 receptors in the bronchi, causing relaxation and bronchodilation. They can cause tachycardia, tremors, and hyperglycemia. They can interact with beta-blockers. SABAs are often combined with ipratroprium.

Methylprednisolone (Solu-Medrol) is a corticosteroid that reduces inflammation and improves work of breathing. It can cause hyperglycemia and is administered intravenously.

Ipratropium, an anticholinergic, antagonizes acetylcholine, leading to bronchodilation. It can cause dry mouth.

Albuterol is a short-acting bronchodilator, while salmeterol is a long-acting bronchodilator used for prevention.

The recommended antibiotic treatment for endocarditis is 4-6 weeks of pathogen-directed therapy. This typically includes a combination of ampicillin, gentamicin, and either flucloxacillin or oxacillin. If a patient is allergic to penicillin, vancomycin and gentamicin can be used instead.

Infective endocarditis is caused by bacteria or fungi, while non-bacterial endocarditis is caused by cancer or autoimmune diseases.

Antivirals, such as acyclovir (herpes) and ganciclovir (cytomegalovirus), anti-inflammatory medications like ibuprofen and prednisone, and heart failure medications like ACE inhibitors, metoprolol, and furosemide are used to manage myocarditis.

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), corticosteroids, and colchicine are medications used to treat pericarditis.

Metoprolol is a beta-blocker that decreases blood pressure and heart rate. Potential side effects include bradycardia, bronchospasm, and hypotension.

ACE inhibitors, such as lisinopril, reduce ejection fraction and cause vasodilation, decreasing blood pressure. They can cause a dry cough, hyperkalemia, angioedema, acute kidney injury, and hypotension.

Acyclovir, an antiviral medication, treats herpes virus myocarditis. It can cause renal dysfunction, nausea, and headache.

Ganciclovir, an antiviral medication, treats cytomegalovirus myocarditis. It can cause neutropenia (low neutrophils) and thrombocytopenia (low platelets).

Colchicine is an anti-inflammatory medication used to prevent recurrent pericarditis. It is contraindicated in patients with renal or hepatic dysfunction.

ACE inhibitors (lisinopril), metoprolol (beta-blocker), nitroglycerin, aspirin, and alteplase are medications given to treat a myocardial infarction.

Aspirin, an antiplatelet agent, prevents blood clots. It can cause bleeding, bronchospasm, and tinnitus.

Nitroglycerin is a vasodilator that reduces preload and afterload, decreasing myocardial oxygen demand. It can cause hypotension, tachycardia, and syncope. It is contraindicated in patients with anemia.

ACE inhibitors, such as lisinopril, lower blood pressure by vasodilation. They can cause a dry cough, hyperkalemia, angioedema, acute kidney injury, and hypotension.

Hypertension urgency is a rapid increase in blood pressure without immediate organ damage. It is often caused by stress, medications, or underlying medical conditions.

Intravenous medications used to treat hypertension urgency include nitroprusside, labetalol, and hydralazine.

Blood pressure should be monitored every 15 minutes during the treatment of hypertension urgency. Aim for a 25% reduction in blood pressure within the first hour, while being cautious of rapid lowering to prevent organ hypoperfusion.

Nitroprusside is a vasodilator used for rapid blood pressure control in hypertension urgency. It can cause cyanide toxicity and tachycardia.

Labetalol is a combined alpha and beta blocker used for rapid reduction in blood pressure in hypertension urgency. It can cause bronchospasm and heart block.

Hydralazine is a vasodilator used for immediate lowering of blood pressure in hypertension urgency. It can cause lupus-like syndrome and tachycardia.

ACE inhibitors, ARB (angiotensin II receptor blockers), beta-blockers, diuretics, and digoxin are medications commonly used to manage heart failure.

Digoxin increases contractility by inhibiting the sodium/potassium pump, increasing intracellular calcium. This boosts cardiac output. It can cause tachycardia, hypotension, and toxicity (nausea, muscle weakness, halo around objects). Avoid in patients with renal disease, and separate antacids by at least 2 hours.

Higher doses of loop diuretics may be needed in patients with severe renal insufficiency or low cardiac output to ensure adequate drug delivery. Bowel wall edema can also affect absorption.

Pulmonic regurgitation is the backflow of blood from the pulmonary artery into the right ventricle. It can be especially problematic when combined with pulmonary hypertension, leading to the progression of right-sided heart failure.

Warfarin, metoprolol or diltiazem, furosemide, and endocarditis prophylaxis (amoxicillin or clindamycin) are medications used to manage valvular disease.