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…
Read moreAs a critical care pharmacist, you will hear debate about the best approach for managing "diuretic resistance" in acute decompensated heart failure . Continue to start IV furosemide at 1 to 2.5 times the TOTAL DAILY oral home dose. For example, if the home oral furosemide dose is 40 mg daily, multiply this by 1 to 2.5 for an …
Read moreAs 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…
Read moreAs 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…
Read moreAs 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…
Read moreAs 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…
Read moreDo 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…
Read moreAs 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…
Read moreGetting POTASSIUM levels right for patients with heart failure can be a balancing act due to changes in medications, diet and kidney function. Hypokalemia and hyperkalemia are common electrolyte disorders caused by changes in potassium intake, altered excretion, or transcellular shifts. Diuretic use and gastrointestinal losses are common causes of hypokalemia, while…
Read moreAs 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 …
Read moreROLE OF LOOP DIURETICS IN TREATMENT OF HEART FAILURE ã…¡ Loop diuretics are recommended for all volume overloaded patients with NYHA class II to IV heart failure to improve symptoms, exercise tolerance, and efficacy of other heart failure medications (e.g., beta-blockers). Thiazide could be used instead of a loop for patients with mild fluid retention and hyperten…
Read moreHow 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…
Read moreRecently, more patients withOUT diabetes will use SGLT2 inhibitors ( Invokana, Forxiga, etc ) for heart failure or kidney disease . That's because growing evidence suggests these medications may improve outcomes when added to standard therapy. In heart failure with reduced ejection fraction (HFrEF), adding Jardiance (empagliflozin) over 16 months prevents hospi…
Read moreLess than half of eligible heart failure patients take an aldosterone antagonist (spironolactone, eplerenone). Help close the gap for patients with systolic heart failure. Now called heart failure with reduced ejection fraction (HFrEF). Think of an angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) , beta-blocker (BB), and aldoste…
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