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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Pts W/ DM and HF
Carvedilol is better than Metoprolol for HF and DM patients
As a clinical pharmacy specialist, cardiologists will ask you for your recommendations on which beta-blockers are better, carvedilol or metoprolol in patients with heart failure and diabetes . There is tantalizing evidence that carvedilol MIGHT be better. But the truth is not so clear. The first head-to-head comparison sugges…
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SGLT-2 Inhibitors
Add SGLT2 inhibitors to your HF patients
As a clinical pharmacist, you will need to ensure appropriate use of SGLT2 inhibitors (empagliflozin, etc), as more hospitals add these medications to formulary. It’s partly because guidelines for heart failure with reduced ejection fraction (HFrEF) now recommend “quad therapy” adding an SGLT2 inhibitor (SGLT2i) to triple therapy , regardless of diabetes. …
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Pts W/ DM and HF
Best DIET in heart failure
As a nutrition support pharmacist, you should advise on the best diet for your patients with heart failure. Previously, the focus on preventing and treating heart failure was to restrict excess sodium intake in order to prevent excess fluid load. While sodium control is still important, macronutrient nutrition may be more important in prevention than previously thou…
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HFrEF Treatment
Starting ENTRESTO for heart failure
As a cardiovascular pharmacist, you will hear lots of buzz about Entresto , a new drug for systolic heart failure. It's the first "angiotensin receptor neprilysin inhibitor" (ARNI) and combines valsartan with sacubitril. Sacubitril works by inhibiting the enzyme neprilysin. This increases sodium loss and vasodilation and enhances ARB efficacy (see figur…
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HFrEF Treatment
Keep NEW heart failure guidelines in mind
As a clinical pharmacist, you should put NEW heart failure guidelines in perspective . Big changes in guidelines will lead to debate about managing heart failure with reduced ejection fraction (HFrEF). We’re used to “triple therapy” for HFrEF; an ACEI or ARB , evidence-based beta-blocker (carvedilol, etc), and aldosterone antagonist (spironolac…
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Milrinone
Use Inotropes for select cases of acute or end-stage heart failure
Do the IV inotropes dobutamine ( Dobutrex, Dobuject ) AND MILRINONE ( Primacor, Milicor ) still have a role in treating heart failure with reduced ejection fraction (HFrEF) ? Yes, but only in a small subset of patients. Both medications increase arrhythmias. And widespread use fell out of favor years ago, due to concerns about increased mortality, especially in pat…
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SGLT-2 Inhibitors
Know the role of empagliflozin (JARDIANCE) in heart failure with preserved ejection fraction
As a pharmacist, you will hear buzz about the role of Jardiance (empagliflozin) in managing heart failure with PRESERVED ejection fraction (HFpEF) . This is in addition to the growing evidence showing benefit of SGLT2 inhibitors in heart failure with REDUCED ejection fraction (HFrEF) . But over half of HF patients have HFpEF, and to date, treatment options for HFpE…
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Iron Therapy
Using IV iron may improve heart failure symptoms
As a clinical pharmacist, you'll hear about using IV iron to improve heart failure symptoms. This is very preliminary, but could be important if it pans out. Up to 20% of heart failure patients are iron deficient which can lead to fatigue and exercise intolerance. Now evidence shows that treating iron deficiency can help patients …
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