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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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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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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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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SGLT-2 Inhibitors
SGLT2 inhibitors for patients without diabetes
Recently, 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…
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Pts W/ DM and HF
Consider heart failure when weighing medications for diabetes
HEART FAILURE is a frequent and often fatal complication of type 2 diabetes and there will be more focus on how this affects medication choices. Consider whether your patient also has heart failure when evaluating diabetes medications, since some may help or harm. Medications with potential benefit Continue to recommend metformin first, it's linked to l…
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Type-2 Diabetes
How to treat type 2 diabetes in heart failure patients?!
Some medications may cause or worsen heart failure . Recommend starting with metformin ( Glucophage ) in most heart failure patients. It improves outcomes and lactic acidosis fears are overblown. Then suggest adding medications that are NOT associated with heart failure such as an SGLT2 inhibitors or "flozin" group ( Jardiance , etc), GLP-1 agonist ( Byet…
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