Mitral Regurgitation Medication

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Class Summary

Help decrease pulmonary congestion.

Furosemide (Lasix)

Increases excretion of water by interfering with chloride-binding cotransport system, which, in turn, inhibits sodium and chloride reabsorption in the ascending loop of Henle and distal renal tubule. Dose must be individualized to patient.

Class Summary

Used in the presence of MR for afterload reduction.

Captopril (Capoten)

Competitive inhibitor of ACE. Reduces angiotensin II levels, decreasing aldosterone secretion. Goal is to decrease afterload to left ventricle (by reducing systemic blood pressure and by peripheral vasodilatation), which decreases amount of blood pumped by left ventricle and pressure at which blood is being ejected. This reduces amount of blood regurgitated by mitral valve from the left ventricle into the left atrium during systole. Elimination of drug is primarily by renal excretion. Impaired renal function requires dosage reduction. Absorbed well PO. Give at least 1 h before meals. If added to water, use within 15 min.

Enalapril (Vasotec)

Competitive inhibitor of ACE. Reduces angiotensin II levels, decreasing aldosterone secretion. Goal is to decrease afterload to left ventricle (by reducing systemic blood pressure and by peripheral vasodilatation), which decreases amount of blood being pumped by left ventricle and pressure at which blood is being ejected. This reduces amount of blood regurgitated by the mitral valve from left ventricle into left atrium during systole.

Lisinopril (Zestril, Prinivil)

Prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in lower aldosterone secretion.

Class Summary

Used for decreasing blood pressure and increasing coronary blood flow.

Nitroglycerin IV (Deponit, Nitro-Bid, Nitrostat, Nitrol)

Causes relaxation of vascular smooth muscle by stimulating intracellular cyclic guanosine monophosphate production. Result is decrease in blood pressure.

Class Summary

Because of its antiarrhythmic properties, digoxin is used if atrial fibrillation is encountered; however, it is not expected to improve overall cardiac function.

Digoxin (Lanoxin)

Cardiac glycoside with direct inotropic effects in addition to indirect effects on cardiovascular system. Acts directly on cardiac muscle, increasing myocardial systolic contractions. Indirect actions result in increased carotid sinus nerve activity and enhanced sympathetic withdrawal for any given increase in mean arterial pressure.

Digitalizing dose is approximately 20% less than PO dose. IM injection offers no advantage and can cause severe pain at injection site. IV is preferred. IV digoxin begins to have effect after 15-30 min and peaks in 1.5-3 h.

Class Summary

Provide subacute bacterial endocarditis prophylaxis. Use prior to any interventional therapy to protect the diseased valves.

Cephalexin (Keflex)

First-generation cephalosporin that inhibits bacterial replication by inhibiting bacterial cell wall synthesis. Bactericidal and effective against rapidly growing organisms forming cell walls.

Resistance occurs by alteration of penicillin-binding proteins. Effective for treatment of infections caused by streptococcal or staphylococci, including penicillinase-producing staphylococci. May use to initiate therapy when streptococcal or staphylococcal infection is suspected.

Used orally when outpatient management is indicated.

Ampicillin (Marcillin, Omnipen)

For prophylaxis in patients undergoing dental, oral, or respiratory tract procedures. Coadministered with gentamicin for prophylaxis in GI or GU procedures.

Amoxicillin (Amoxil, Trimox)

Interferes with synthesis of cell wall mucopeptides during active multiplication, resulting in bactericidal activity against susceptible bacteria. Used as prophylaxis in minor procedures.

Clindamycin (Cleocin)

Used in patients who are allergic to penicillin and are undergoing dental, oral, or respiratory tract procedures. Useful for treatment against streptococcal and most staphylococcal infections.

Gentamicin (Garamycin)

Aminoglycoside antibiotic for gram-negative coverage. Used in combination with both an agent against gram-positive organisms and one that covers anaerobes. Used in conjunction with ampicillin or vancomycin for prophylaxis in GI and GU procedures.

Vancomycin (Vancocin)

Potent antibiotic directed against gram-positive organisms and active against enterococcal species. Useful in treatment of septicemia and skin structure infections. Indicated for patients who cannot receive, or have not responded to, penicillins and cephalosporins or who have infections with resistant staphylococci.

Use CrCl to adjust dose in patients diagnosed with renal impairment.

Used in conjunction with gentamicin for prophylaxis in patients who are allergic to penicillin and are undergoing GI or GU procedures.

Erythromycin (EES, E-Mycin, Eryc)

Used for prophylaxis in patients who are allergic to penicillin and are undergoing dental, oral, or respiratory tract procedures.

Azithromycin (Zithromax)

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Clarithromycin (Biaxin)

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Cefazolin (Ancef)

First-generation semisynthetic cephalosporins that arrest bacterial cell wall synthesis, inhibiting bacterial growth. Primarily active against skin flora, including Staphylococcus aureus.

Cefadroxil (Duricef)

First generation semi-synthetic cephalosporin, that arrests bacterial growth by inhibiting bacterial cell wall synthesis. Bactericidal activity against rapidly growing organisms. Primarily active against skin flora, including Staphylococcus aureus.