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.
Novel Potassium-Lowering Agents in Combination with Chronic Heart Failure Therapies
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.
Upstream P2Y12 Inhibitors and the CABG Quandary
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.
Mineralocorticoid Receptor Antagonists: The Cardiovascular Wonder Class (Part 2)
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: The Cardiovascular Wonder Class (Part I)
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.
Should Tolvaptan be Used Routinely in Patients with Acute Decompensated Heart Failure? Na.
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?
Should we be SPRINTing to Lower Blood Pressure Goals in Older Patients?
Recommended blood pressure goals vary among national practice organizations. One area of controversy is the blood pressure goal for older patients. This piece will review the differences in the recommended blood pressure goals as well as data that may enable clinicians to establish an individualized blood pressure goal for their older patients.
Which Patients with Heart Failure Should Get Loop Diuretics as a Continuous Infusion? (Part 2)
In Part 1 of this two-part series, we highlighted some of the limitations of the Diuretic Optimization Strategies Evaluation (DOSE) trial as well as populations in whom continuous infusions of loop diuretics may have advantages over intermittent boluses. In Part 2, we will review some of the disadvantages associated with continuous infusions, as well as pearls for optimally managing them in patients with acute decompensated heart failure.
Which Patients with Heart Failure Should Get Loop Diuretics as a Continuous Infusion? (Part 1)
In the Diuretic Optimization Strategies Evaluation (DOSE) trial, intravenous boluses of loop diuretics were shown to as efficacious and safe as continuous infusions in patients with acute decompensated heart failure. However, the heterogeneity of the population enrolled in DOSE makes it difficult to identify patient populations who might actually benefit from one strategy over another. In Part 1 of this two-part series, we’ll explore several potential populations in whom continuous infusions may be beneficial over intermittent boluses.
Innovation on Rotation: Incorporating Active Learning Strategies
As a preceptor, can you recall a time when a student or resident forgot a fundamental concept? This is a common frustration, but the issue may not be poor understanding or lack of interest in the topic. Rather, the learner may be struggling with assimilating all of information acquired during the rotation experience. Active learning is an effective strategy in the classroom setting and has been shown to increase retention of knowledge. In this blog, we will explore several active learning techniques and how they can be applied to experiential learning.