Type-2 Diabetes
Don't use DIABETES as a CV risk equivalent
As a pharmacy doctor, you will see more consensus on using statins for diabetes patients. We all know the controversy about the ACC/AHA cholesterol guidelines that abandoned LDL goals and recommended specific statin doses instead. Now the American Diabetes Association is following suit and providing similar guidance on when to use a statin in diabetes patients. …
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Optimizing Meds
Optimizing meds in patients with HFrEF and CKD
Few patients with chronic kidney disease (CKD) are on optimized meds for heart failure with reduced ejection fraction (HFrEF) . It’s a delicate balance... Hyperkalemia can occur with an ACEI or ARB, Entresto (sacubitril/valsartan), or an aldosterone antagonist. Plus, these meds or SGLT2 inhibitors ( Forxiga, etc ) can cause an initial bump in serum creatinine…
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Stroke
DAPT after an ischemic stroke or TIA?
New data will raise questions about optimal use of short-term dual antiplatelet therapy (DAPT) after an ischemic stroke or TIA. We know that short-term DAPT, such as aspirin plus clopidogrel for 21 days, reduces recurrent stroke risk compared to aspirin alone. But most evidence is with starting DAPT within 24 hours. And data are mostly for patients with a minor st…
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Locodo
Know COLCHICINE's role in chronic coronary disease
As a cardiovascular pharmacist, you’ll hear buzz about new Rx colchicine ( Lodoco ) for patients with chronic coronary disease. There’s been growing interest in using colchicine to reduce CV risk, due to its anti-inflammatory effect... 💊⚕️ Lodoco is the same drug we use for gout , but it’s 0.5 mg instead of 0.6 …
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Hypertension Medications
FAQs on First-Line BP Meds
As a clinical pharmacist, you often encounter questions about choosing blood pressure medications for the initial treatment of uncomplicated hypertension. We know to turn to an ACEI or ARB , calcium channel blocker (CCB) , or thiazide first, CV benefits seem similar overall. But be ready with answers to common questions about nuances... …
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Pregnancy HTN
Guide use of BP meds during pregnancy
As a cardiovascular pharmacist, more questions arise about managing chronic hypertension in pregnancy due to increasing maternal age, obesity, etc. We know to treat all pregnant patients with severe hypertension 160/110 mm Hg or above. But treatment of nonsevere chronic hypertension, such as 140/90 or more, hasn’t been clear-cut, due to limited evidence. …
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Pts W/ DM and HF
Angiotensin-converting enzyme (ACE) inhibitors
Therapeutic actions ㅡ ACE inhibitors block ACE in the lungs from converting angiotensin 1, activated when renin is released from the kidneys, to angiotensin 2, a powerful vasoconstrictor. Blocking this conversion leads to decreased BP, decreased aldosterone secretion, a small increase in serum potassium levels, and sodium and fluid loss; increased prostaglandin synth…
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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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Dual Antiplatelet Therapy
DAPT duration for patients at HIGH bleeding risk
As a cardiovascular pharmacist, you will hear debate about shorter dual antiplatelet therapy (DAPT) durations after a stent in acute coronary syndrome (ACS) . The standard has been DAPT with aspirin AND a P2Y12 inhibitor ( clopidogrel , prasugrel, or ticagrelor ) for 12 months, with the option to extend for those at high thrombotic and low bleeding risk. …
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Nephrology and Urology
Can we use fondaparinux in RENAL patients?
As a clinical pharmacy specialist, it is important to address the safety of using fondaparinux ( Arixtra ) in renal patients with a creatinine clearance (CrCl) less than 30 mL/min. Fondaparinux is primarily used subcutaneously (SQ) for the treatment and prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE). According to the 2018 American Society of …
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Statins
Think "LOWER IS BETTER" for LDL in high CV risk patients
As a cardiovascular pharmacist, there is an ongoing debate regarding the necessity of aiming for a specific LDL goal. For over a decade, the focus has been on using target DOSES of statins shown to reduce CV risk , rather than titrating to an LDL goal. But there’s been a shift toward a blended approach in recent years. Data comparing specific LDL targets are limited.…
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