Anticoagulants account for 5-10% of drug errors that occur in the hospital. Part 2 of this 2-part series on anticoagulation safety will focus on the role of anticoagulation stewardship, including what it entails, who is involved, and why it is important.
Beta blockers remain a cornerstone in the management of several cardiovascular disorders yet many clinicians are reluctant to use them in the setting of cocaine abuse. In this entry, we take a look at the evidence.
Physical examination has become a “lost art” for many clinicians across a variety of disciplines. Many pharmacists have not had formal physical examination training in school and those that have rarely utilize these skills after completing their training. Pharmacists are poised to employ physical examination in their patient care setting to evaluate the effects of therapy, triage patients, and guide clinical decision-making. This piece describes a general overview of the importance of physical examination and provides readers with a list of tools that pharmacists can use to reinforce prior knowledge of the cardiovascular physical examination.
Evidence from randomized controlled trials has demonstrated that the cornerstone pharmacologic therapies used in the management of chronic heart failure with reduced ejection fraction (HFrEF) do not confer the same benefits in patients with preserved ejection fraction (HFpEF). So why do we enroll both subgroups in trials of acute decompensated heart failure (ADHF)? In this entry, we’ll explore differences in pathophysiology between HFrEF and HFpEF and how they may result in variable responses to pharmacologic therapies commonly used in ADHF, particularly diuretics and vasodilators.
Anticoagulants are some of the most commonly implicated drugs in emergency department visits and hospitalizations due to adverse drug events. Medication errors can significantly influence these events, and pharmacists are at the forefront for preventing medication errors from reaching the patient. Part 1 of this 2 part series on anticoagulation safety will focus on common medication errors involving direct oral anticoagulants. Part 2 will focus on ways pharmacists can help prevent medication errors with anticoagulants, particularly as it relates to anticoagulation stewardship programs.
Agents such as patiromer and sodium zirconium cyclosilicate can reduce serum potassium concentrations. But do they have a role in patients with heart failure with reduced ejection fraction (HFrEF)? In this piece, we explore whether these agents could reduce the risk of hyperkalemia when initiating, continuing, or dose-titrating guideline-directed medical therapies in HFrEF.
Given the extensive role that platelet activation and aggregation play in the pathophysiology of acute coronary syndromes, it seems reasonable to administer a P2Y12 inhibitor as early as possible to minimize thrombus formation and progression of ischemia. Nonetheless, there remains considerable controversy surrounding the optimal timing of P2Y12 inhibitor administration in those undergoing percutaneous coronary intervention. In this blog, we’ll explore the data for and against early P2Y12 inhibitor administration in those presenting with non-ST-segment-elevation acute coronary syndromes and how coronary artery bypass graft surgery should, or should not, impact the decision for when to administer P2Y12 inhibitors.
In Part 1 of this two-part series, we dissected the evidence behind the use of MRAs in HFrEF, HFpEF and MI to further understand the reasons for their underutilization and alleviate some of those concerns. In Part 2, the use of MRAs in resistant hypertension will be discussed, as well as considerations regarding blood pressure, potassium, and renal effects given these may play key roles in precluding MRA use when warranted.
Mineralocorticoid receptor antagonists are arguably one of the most underutilized medication classes despite sound evidence supporting their use across a spectrum of cardiovascular diseases. Part 1 of this two-part series chronicles current evidence evaluating the use of MRAs, particularly spironolactone, in the treatment of heart failure (both chronic and acute settings) and myocardial infarction.
In TACTICS-HF, tolvaptan failed to provide a clinically meaningful benefit in patients with acute decompensated heart failure, although patients were enrolled without respect to serum sodium concentrations. Given a consistent trend of disappointing results, does a routine role for the drug exist now or in the future?