SGLT-2 Inhibitors
HFpEF Treatment Options
As a clinical pharmacy specialist, you will get questions about managing heart failure with PRESERVED ejection fraction (HFpEF), based on new guidance. Over half of HF patients have HFpEF, with an ejection fraction of 50% or higher. But treatment of HFpEF is still less clear-cut than heart failure with REDUCED ejection fraction (HFrEF) , since HFpEF data are less rob…
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HFrEF Treatment
How to DOSE medications for systolic heart failure
As a cardiovascular pharmacist, you will be asked more how to dose medications for systolic heart failure. Many cardiac conditions rely on a key "number" to determine drug efficacy. For example, blood pressure guides hypertension treatment and LDL levels guide dyslipidemia therapy . But there's no key number to measure efficacy for heart failure . I…
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Hypertension
How to treat MILD hypertension
As a cardiovascular pharmacist, you will hear debate about when to start drugs in patients with MILD hypertension, systolic blood pressure (BP) 140 to 159 mmHg or diastolic 90 to 99 mmHg. The latest analysis questions whether BP drugs benefit stage 1 or mild hypertension. It suggests that only one cardiovascular (CV) event is prevented for ever…
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Renal Function
Expect a serum creatinine bump when starting an ACEI or ARB in kidney disease
How to safely use ACEIs or ARBs in patients with chronic kidney disease, this is an important question. We know these medications slow the progression of kidney disease. But blocking angiotensin can reduce kidney filtration and sometimes lead to a bump in serum creatinine (SCr) and potassium. See " Algorithm (1) of using ACEI or ARB after AKI ". …
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Nephrology and Urology
Risk of acute kidney injury when adding NSAID to diuretic plus ACEI or ARB
As a clinical pharmacist, you'll hear more about the risk of acute kidney injury when adding an NSAID to a diuretic plus an ACEI or ARB . Combining all three agents creates a "triple whammy" to impair kidney function and sometimes the kidneys can't compensate. This is especially true in patients at risk due to age over 65, chronic kidney disease, o…
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Spironolactone
Managing diastolic or preserved ejection fraction heart failure (HFpEF)
How to treat "DIASTOLIC" heart failure or heart failure with a PRESERVED ejection fraction (HFpEF)? Over HALF of heart failure patients have this type, which is due to a stiff left ventricle that can't adequately fill. This is different from "SYSTOLIC" heart failure or heart failure with a REDUCED ejection fraction (HFrEF). These patients have…
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Side Effects
Using of potassium binders when ACEIs or ARBs cause hyperkalemia
New Rx Lokelma will pique interest in the role of potassium binders to treat CHRONIC high potassium due to ACEIs or ARBs. Think of Lokelma (sodium zirconium cyclosilicate) as most similar to sodium polystyrene sulfonate ( Kayexalate , etc) for hyperkalemia. Both exchange sodium to bind potassium. Lokelma also exchanges hydrogen. But Lokelma may cause fewer GI side e…
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Loop Diuretics
Overview of HEART FAILURE treatment
Overview ㅡ Heart failure typically classified by New York Heart Association (NYHA) I-IV functional classification or American College of Cardiology Foundation/American Heart Association (ACCF/AHA) A-D staging ( see table 1 ) . Heart failure with reduced ejection fraction (HFrEF) or systolic heart failure results in decreased heart pump function (left ventricular ejec…
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Hypertension
Be ready to manage patients with very high blood pressure
What should you do when patients report a very high blood pressure (BP) reading on a home monitor or pharmacy? Don't automatically refer to the emergency department (ED) for a blood pressure above 180/120 mmHg. Advise promptly rechecking BP, and ensure proper technique, sit quietly for 5 minutes, appropriate cuff size, feet on the floor, etc. And shift the foc…
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Nicorandil
Nicorandil, serious side effects (ulceration)
This article was written by: Islam M. Eid, BS Pharm, PGDipClinPharm. Senior Out-patient Pharmacist, Pharmacy Practice Department, Tanta Universal Teaching Hospital, Tanta University. Introduction ㅡ Angina is a pain that comes from the heart. It is usually caused by narrowing of one or more of the arteries that s…
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Nephrology and Urology
How to safely use ACEIs or ARBs in patients with chronic kidney disease
ACEIs or ARBs can slow the progression of kidney disease. But initially they can bump up serum creatinine (SCr) and potassium, sometimes causing the ACEI or ARB to be stopped too soon. Think of ACEIs and ARBs as the "beta-blockers of the kidney." Expect increases in serum creatinine (SCr) just as you expect beta-blockers to decrease heart rate. Although th…
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Nephrology and Urology
ACE inhibitors or an ARB for hypertension or diabetic kidney disease
A shift in thinking about the cardiovascular (CV) benefits of angiotensin receptor blockers (ARBs) will lead to more use of angiotensin receptor blockers (ARBs) instead of angiotensin converting enzymes inhibitors (ACEIs). ACEIs are mostly recommended to be used, since they have more CV outcomes data and seemed to have a bigger impact on CV events than ARBs. And low-…
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Myocardial Infarction
Angiotensin II receptor blockers (ARBs)
Therapeutic actions ㅡ ARBs selectively block the binding of angiotensin II to specific tissue receptors found in the vascular smooth muscle and adrenal gland. This action blocks the vasoconstriction effect of the renin-angiotensin system as well as the release of aldosterone leading to decreased BP; may block vessel remodeling that occurs in hypertension and contribu…
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Nephrology and Urology
How to restart ACEI or ARB in patients after acute kidney injury (AKI)?!
A common scenario that leads to kidney injury is when patients on an ACEI or ARB start an NSAIDs, diuretic, or become dehydrated . Many references suggest using an ACEI or ARB after acute kidney injury is linked to lower mortality. BUT still at the risk of hyperkalemia. If it was stopped because of acute kidney injury, weigh benefits and risks to help decide about re…
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