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Calcium Channel Blockers

Leave a Comment / Cardiology, Top 200 Drugs /
Calcium channel blockers (CCBs) are used in the treatment of many cardiovascular conditions. They are divided into subclasses, non-dihydropyridines and dihydropyridines. The non-dihydropyridine CCBs cause less vasodilation and more cardiac depression than dihydropyridine CCBs (hence why they are not recommended in decompensated heart failure). They cause reductions in heart rate and contractility. Dihydropyridine CCBs have more vascular selectivity and fewer cardiac effects. They are indicated in the treatment of hypertension and angina. They do not suppress AV conduction or the SA node automaticity.

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Learn with Memory Pharm on Youtube

Leave a Comment / General, Other Learning Resources, Update /

*Drum roll* Announcing the launch of Memory Pharm’s Youtube channel!

We are so excited to share the great news. For all of our visual and audio learners, these videos are aimed to help you understand medications in a fun and effective way.  With tons of great illustrations and animations PLUS memorization tips, we hope these videos will help make learning medications easier and more enjoyable. It is a great tool all healthcare professionals currently in school and a nice review for practicing clinicians. If this is you, check out our channel below. 

Click here to watch now!

Our first two videos are on the topic of asthma, a common respiratory disorder that affects millions of people worldwide. Stay tuned for more videos coming soon. Until then, happy studying!

-Memory Pharm Team

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Asthma 2: Asthma Medications Made Simple

Leave a Comment / Pulmonology /

Think of yourself as a visual learner? Check out our video above that uses graphics and animations to discuss the material below!

Main Asthma Medications:

The main medications used to treat chronic asthma are easiest to remember using the following mnemonic. 

I like lazy Saturdays!

I is for inhaled corticosteroids because I come first to help you remember that they are the first line of treatment in asthma!  Like is for leukotriene modifiers, Lazy is for long acting beta-2 agonist (these are used even on a lazy day!) Saturdays is for short acting beta-2 agonist because on Saturday college football players may require a short acting beta-2 agonist.  Let’s dive into each of these further.

Treatment Goal: 

The goals of asthma treatment are to prevent chronic symptoms that can interfere with daily living, and decrease the need for rescue inhalers, maintain pulmonary function and activity level, and prevent exacerbations.

Inhaled Corticosteroids:

Inhaled corticosteroids are considered the key controller medications that work by reducing inflammation specifically in the lungs. They do this by binding onto glucocorticoid receptors which go on to inhibit the transcription of inflammatory genes such as cytokines as well as the activation of esoinophils and the release of inflammatory mediators. Cytokines are like your messenger proteins that alerts other immune system cells to the site of inflammation. Eosinophils are a type of white blood cell that can cause inflammation and swelling. The inflammatory mediators like leukotrienes, histamine, or prostalgandins directly lead to the symptoms of inflammation. By inhibiting them, this reduces the hyperinflammatory cascade that leads to bronchial hyperreactivity, swelling and mucus production, making it easier to breath and preventing future asthma attacks.

It is the preferred medication for controlling asthma over the long term since hyperinflammation is the main cause of asthma. Examples include: 

  • Budesonide (Pulmicort)
  • Beclomethasone (QVAR)
  • Fluticasone (Flovent),
  • Mometasone (Asmanex)
  • Clicosenide (Alvesco)

Steroids often end in the suffix ‘onide’ or ‘-asone’ similar to prednisone or cortisone (naturally occurring corticosteroid). 

Luckily, Inhaled corticosteroids work locally and have relatively few side effects compared to oral corticosteroids. The common side effects of inhaled corticosteroids can be remembered using the mnemonic HOCUS:   

  • Hoarseness
  • Oral thrush/candidiasis (Be sure to counsel patients to rinse their mouth and throat with warm water and spit to prevent this from occuring)
  • Cough
  • Upper respiratory tract infections (is rare and often occurs with high doses or long-term use)
  • Sore throat

Inhaled Beta-2 Agonists:

Beta-2 agonists are bronchodilators that work to relax the smooth muscle bands that tighten around the airways and are divided into two forms, short-acting and long-acting beta-2 agonists. These forms differ by their duration of action with short acting beta-2 agonists working rapidly within 5 minutes to reverse bronchoconstriction and relieve or stop asthma symptoms which makes this a great rescue inhaler. Long-acting beta-2 agonists help keep the airways open for 12 hours or longer and are used on a daily basis to prevent asthma attacks.

Beta-2 agonists work by binding on to beta-2 receptors located on smooth muscles of the airways in the lungs. If you can recall, beta-2 receptors are commonly located on the lungs while beta-1 receptors are mainly located on cardiac muscles. Remember, we have 2 lungs (beta-2) and 1 heart (beta-1).

Activation of beta-2 receptors causes an increase in cyclic AMP which leads to a decrease in calcium release. Since calcium plays a big role contraction, a decrease in calcium leads to a decrease in contraction of airway smooth muscles and bronchodilation.

Beta-2 agonists can cause some unwanted side effects with the heart at high doses such as increased heart rate, palpitations, blood pressure, and anxiety. You can remember this as the beta symbol also looks like a heart turned sideways. Other side effects include tremors, hyperglycemia, hypokalemia, and cough.

It is important to monitor how often patients are using their rescue inhaler as frequent use can indicate that their asthma is not under control. Other things to monitor include BP, HR, blood glucose and potassium. Also, since this class of medications works quickly, they are often used prior to exercise or in exercise induced asthma. They can be taken 5-15 minutes before exercise and last 2-3 hours. Remember back to how the football player may need this on the sidelines at his Saturday game?

 

Beta 2 agonists mechanism of action

Activation of beta-2 receptors causes an increase in cyclic AMP which leads to a decrease in calcium release. Since calcium plays a big role contraction, a decrease in calcium leads to a decrease in contraction of airway smooth muscles and bronchodilation.

Beta-2 agonists can cause some unwanted side effects with the heart at high doses such as increased heart rate, palpitations, blood pressure, and anxiety. You can remember this as the beta symbol also looks like a heart turned sideways. Other side effects include tremors, hyperglycemia, hypokalemia, and cough.

It is important to monitor how often patients are using their rescue inhaler as frequent use can indicate that their asthma is not under control. Other things to monitor include BP, HR, blood glucose and potassium. Also, since this class of medications works quickly, they are often used prior to exercise or in exercise induced asthma. They can be taken 5-15 minutes before exercise and last 2-3 hours. Remember back to how the football player may need this on the sidelines at his Saturday game?

Long-acting beta-2 agonist or LABA works just like a SABA, it just lasts longer with a duration of action of 12 hours and are used with a twice daily dosing regimen.  Examples include salmeterol and formoterol.

You can remember this because they contain words similar to metro in their names. Metro trains run long distances, so these are long-acting.

 

Because they have no anti-inflammatory action, these medications should not be used alone in asthma due to increased risk of asthma-related deaths.  That is why they are often found in combination with an inhaled corticosteroid like Symbicort which includes budesonide and formoterol or Advair including salmeterol and fluticasone. 

Side effects are similar to short-acting beta2 agonist. Remember, long-acting beta-2 agonists with inhaled corticosteroids are considered controller medications and should be taken daily even on a lazy day to prevent asthma exacerbations. 

Now that we have talked about specific counseling points about the different types of inhaled medications, let’s review how to counsel a patient on using their metered dose inhaler using the mnemonic: SPORTT

  • Shake well before each use
  • Prime before first use by shaking well for 5 seconds and then spraying into the air 3 times.  This should be repeated if the inhaler has not been use for more than 7 days.
  • Out. Take a deep breath and breathe out all the way
  • Rest the inhaler in the mouth and close your lips around it.
  • Take a deep breath in as you press all the way down on the inhaler to release the medication.
  • Ten seconds. Hold your breath for as long as you can up to 10 seconds

Spacers should be used for children as they help to ensure proper delivery of the medication

There are several different types of inhalers that deliver medications in a slightly different way such as dry powder inhalers, respimats, accuhalers, elliptas and more. Always double check the package inserts when educating patients on how to use their new inhaler.   

Leukotriene Modifiers:

Leukotriene modifiers are a great add on therapy in patients with allergies since they block the action of leukotrienes. If you can recall, leukotrienes are a type of proinflammatory chemicals that cause bronchiole smooth muscle contraction as well as recruit other proinflammatory mediators such as histamine and prostaglandin into tissues. By inhibiting leukotrienes, we can see a reduction in airway swelling, smooth muscle contraction, inflammation and nasal congestion often associated with allergies. 

Examples include: 

  • Montelukast
  • Zafirlukast
  • Zileuton

They all have the suffix “-luk” in the name reminding you that it is a Leuk-otriene modifier. 

Clinical pearl! This class of medications is dosed based on age not weight.  Other side effects include headache, dizziness, abdominal pain, increased LFTs, upper respiratory infections, sinusitis, and pharyngitis.  Behavior and mood changes are rare side effects that include aggressive behavior, agitation, hostility, depression and/or suicidal thoughts and is an important counsel point for patients. Though this may all sound like a lot, they are relatively well tolerated.

Theophylline:

Theophylline is an oral bronchodilator medication that you may see in the treatment of asthma. Its use has declined due to the greater efficacy of inhaled corticosteroids and beta-2 agonists as well as the numerous drug interactions and side effects associated with it (nausea, headache, tachycardia, insomnia, tremor, and nervousness, arrhythmias, confusion, seizures).

It has a narrow therapeutic index of 10-20 mcg/mL and requires frequent lab draws to monitor drug levels. It’s mechanism of action is not fully known but it is believed to block phosphodiesterase resulting in bronchodilation and mild anti-inflammatory effects.  

Inhaled Anticholinergics:

Short-acting inhaled anticholinergics such as ipratropium can commonly be used with beta-2 agonists in acute asthma exacerbations. They inhibit acetylcholine from binding onto muscarinic receptors on airway smooth muscle cells (hence why they are called anti-cholinergics) leading to bronchodilation. They have few side effects (mainly just dry mouth that is common with tiotropium) due to the fact that they are inhaled locally and are poorly absorbed into the circulation. Long-acting inhaled anticholinergics (Spiriva or tiotropium) provide modest improvements in asthma exacerbations and are reserved in patients with uncontrolled asthma despite being on an ICS-LABA.

Omalizumab (Xolair):

Omalizumab (Xolair) is a subcutaneous injection made of IgG monoclonal antibodies that inhibit IgE binding to mast cells. If you can recall, IgE is one the main culprits that lead to asthma symptoms. Omalizumab is indicated in patients with moderate to severe persistent allergic asthma despite being on max doses of ICS-LABA. It has a box warning for anaphylaxis and requires that it be administered in a healthcare setting where patients can be monitored. Other side effects include injection site reactions, muscle pain, dizziness, fatigue, and dermatitis. 

Wrapping it up:

To wrap it up, when initiating medications in a newly diagnosed asthma patient, assess their symptoms and start them on a rescue inhaler such as a short-acting beta2 agonist as needed. If their symptoms worsen, they can escalate therapy using higher doses of their controller medications. Lastly, if a patient has allergies and is not responding to other therapies, they may benefit from an add-on medication such as a leukotriene modifier.

Asthma 2: Asthma Medications Made Simple Read More »

Asthma 1: What is asthma?

Leave a Comment / Pulmonology /

Think of yourself as a visual learner? Check out our video above that uses graphics and animation to discuss the material below!

Definition:

Asthma is often defined as a chronic inflammatory disorder of the airways.

So what does that mean? Well normally, our body has an amazing filtering system for the air we breathe that starts at our nose. Our nose secretes this thick and sticky substance called mucus that traps unwanted particles like dirt, pollen, or smoke. Small hairs called cilia move in wave like motions pushing the mucus to the back of our throat where it either gets swallowed or spit out.  Have you ever noticed a lot of post-nasal drip during pollen season?  As irritating as it can be, that is your nose is working overtime to clear out the pollen before it reaches your lungs.  This is completely normal and our body’s way of protecting us from particles that may contain bacteria or viruses that can lead illnesses.

Pathophysiology:

In asthma, the body’s inflammatory process goes into overdrive! This occurs when the immune system is exposed to something called an allergen or trigger such as pollen, pet dander, smoke, or mold. It mistakenly tags it as something bad by producing antibodies to it called IgE. 

Upon reexposure to the same allergen, the body’s hyperinflammatory system remembers the allergen and causes the release of IgE antibodies that bind to and activate mast cells. Mast cells are a type of immune cell that function as the body’s first line of defense against harmful allergens preventing them from entering the body. They do this by releasing granules that contain such as histamine, prostaglandin and leukotriene. These granules sound fancy but they are just names for types of mediators of anaphylaxis. These mediators go on to cause constriction of the airway smooth muscle and increase mucous production. This process is something called the ‘early asthmatic response. This is followed 3-6 hours later by a ‘late asthmatic response’ where proinflammatory cytokine proteins recruit and activate additional immune cells such as eosinophils that contribute to continued and sustained bronchoconstriction and mucous production.

Symptoms:

These series of events lead to the symptoms of asthma including: 

  • Wheezing
  • Breathlessness
  • Chest tightness
  • Coughing

In asthma, the smooth muscles around the airways tighten and shrink  making them narrower leading to chest tightness. In addition, overproduction of mucous produces mucous plugs throughout the lining of the airway that can cause coughing. This makes it tough to move air through and almost causes a whistling sound as air passes through the narrow space. This is known as wheezing. The narrow and inflamed airways not only lead to decrease oxygenation but also decrease ventilation as air gets trapped inside the lungs. The increase work of breathing to get air in and out can lead to exhaustion and breathlessness as seen in patients with asthma.

Diagnosis:

In addition to the patient’s symptoms, medical history and physical exam, physicians commonly use a spirometer to diagnose asthma. A spirometer is a device used to measure the volume of air inspired and expired by the lungs. A physician will have a patient use the spirometer after administering a medication called a beta agonist. If there is an improvement in the spirometry readings after using the beta agonist, this is a good indication of asthma since it is reversible with medications, unlike COPD. Once the diagnosis is confirmed, initial asthma management depends on how often they have symptoms such as nighttime awakenings, the need for a rescue inhaler to control symptoms, activity limitations due to asthma and daytime symptoms.

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Pharmacology Study Tips

Leave a Comment / Other Learning Resources /

If studying pharmacology seems like a daunting task, you are not alone. It is probably one of the most challenging subjects for every student to learn owing to the amount of drug information that needs to be committed to memory. Some might even say it is similar to memorizing a dictionary!

You cannot possibly learn everything about all the drugs available on the market. So, where do you start? Check out these top 5study tips below!

Study Tip #1: Group the information

 

You only have a limited time to study; therefore, you want to get the most bang for your buck. The grouping technique, also known as the chunking method, is an effective way to organize information to enhance the amount of information you can retain to memory. Our brains naturally file things into categories. During exams and in clinical practice, we get asked questions that require us to retrieve information that is grouped (e.g., which antibiotic can I give in a patient with renal insufficiency? anti-nausea medication should I prescribe?) so studying information in this format is ideal.

 

Here is how you can group the information:

  • Group the drugs by their class (e.g., cephalosporins, calcium channel blockers, etc.)
  • Mechanism of action of that drug class
  • Side effects common to that drug class
  • Side effects that are unique to a drug in that class
  • Commonalities of drug names in that group of class
  • Indications for that drug class
  • Unique drug interactions for that drug class/drugs
  • Pregnancy considerations for that drug class/drug

 

Study Tip #2: Ask yourself these 2 questions

 

Rather than memorizing information for the exam and then dumping it after, studying with these two questions in mind will help you retain the information longer and improve your confidence. They will help you understand the underlying pathophysiology and why we use certain drugs in certain disease states.

 

  1. What normally happens in the body?
  2. What is going wrong when this disease state happens?
 

Study Tip #3: Understand the mechanism of action

 

If you know this one fact about the drug class, it can help you remember the indication and some of the side effects. For example, lisinopril works by inhibiting an enzyme that converts angiotensin I to angiotensin II, a hormone that causes vasoconstriction of blood vessels leading to hypertension. Less of this active hormone leads to a decrease in blood pressure. From this, you’ll know that lisinopril is used to treat hypertension and some common side effects include hypotension, dizziness, and headache. 

 

This study tip may not be possible for all drugs as some medications (e.g., antiepileptics) have unknown mechanisms of action. 

Study Tip #4: Use mnemonics

 

Mnemonics are popular memory tools used to aid in committing important pharmacology facts. Below are 5 different pharmacology mnemonics that you can use to help you during your studies.

 

Acronyms

Acronym-based mnemonics use the first letters of the target words to assist in remembering large amounts of information. For example, to remember the side effects of statins, think of the acronym HMGCoA: Hepatotoxicity, Myalgia, GI effects (nausea, flatulence), CPK increase, and Avoid in pregnancy.

 

Drug names

Drug companies often name drugs with stem words that hint at their class or mode of action. For example, riivaroxaban, apixaban, edoxaban are direct factor Xa inhibitors as denoted by the stem -xa in their names. Macrobid is dosed BID versus Macrodantin is dosed four times a day. Pay attention to the drug name when studying to see if you can spot some of these stems. 

 

Keyword mnemonics 

Use sound-alikes to help you associate the word to a new key term. Of the second-generation antipsychotics, risperidone and paliperidone have the highest risk for EPS and tardive dyskinesia. Mnemonic: “Movement disorders are no fun, so don’t RISK (Risperidone) it Pal (Paliperidone)!”

Grouping method  ALL antibiotics need to be renally adjusted. The list is endless. It is usually easier to remember the outliers or those that do not need to be renally adjusted: moxifloxacin, linezolid, clindamycin, nafcillin, tigecycline. 

Comprehension Understanding is always best for long-term retention! For example, the respiratory fluoroquinolones are gemifloxacin, moxifloxacin, and levofloxacin (remember Go, My Lungs!). There is a common misconception that ciprofloxacin has poor lung penetration because it isn’t a respiratory FQ when the actual reason is that it lacks activity against streptococcus pneumoniae, a common bacteria that causes pneumonia.

Study Tip #5: Check out Memory Pharm!

 

Memory Pharm is a educational website that aims at simplifying complicated pharmacology topics using humor and practicality. We are updating our content regularly. Check out our social media for weekly drug facts, mnemonics, and encouragement as well as subscribe to our email listing to get the latest updates and tips exclusive to members of our list.

Pharmacology Study Tips Read More »

Calcium Channel Blockers

Leave a Comment / Cardiology /

Calcium channel blockers (CCBs) are used in the treatment of many cardiovascular conditions including hypertension and angina. They are divided into subclasses, non-dihydropyridines and dihydropyridines and differ by their pharmacokinetic properties, clinical uses, response, and selectivity.

 

Key Points

The non-dihydropyridine CCBs do not end in the suffix ‘-ine’ hinted by the name of the subclass, non-dihydropyridines. They cause more cardiac depression and less vasodilation than dihydropyridine CCBs resulting in a reduction in heart rate and cardiac contractility.

  • Verapamil
  • Diltiazem

 

Dihydropyridine CCBs end in the suffix ‘-ine’ and have more vascular selectivity and fewer cardiac effects. They act primarily as peripheral vasodilators and are used in the treatment of hypertension and angina. They do not suppress AV node conduction or SA node automaticity.

  • Amlodipine
  • Nicardipine
  • Nifedipine
  • Nimodipine
  • Felodipine

 

Mechanism of Action:

The name of this class, calcium channel blockers, hints at its mechanism of action – inhibits the entry of calcium into cells of the cardiac and peripheral vascular smooth muscles. 

  • Calcium entry into L-type channels of cardiac and peripheral vascular cells is needed for them to contract or constrict more strongly. 
  • By blocking calcium entry, calcium channel blockers cause 
    • peripheral vascular smooth muscle relaxation (decreases blood pressure)
    • decreased myocardial contractility (decrease myocardial demand making them effective in angina)
    • decrease heart rate and conduction velocity (useful in arrhythmias). 

Indications:

Non-dihydropyridines 

  • Hypertension
  • Arrhythmias

Dihydropyridines

  • Hypertension
  • Angina
  • Migraines

 

Side Effects: 

The main side effects of calcium channel blockers are hypotension and dizziness which is related to their effects on vasodilation so it is easier for you to memorize. 

In addition, they can also cause the following side effects by subclass:

  • Non-dihydropyridines
    • Constipation, gingival hyperplasia, worsening cardiac output, and bradycardia.
  • Dihydropyridines
    • Peripheral edema, headache, flushing

Clinical Pearls/Education:

  • Non-dihydropyridines are contraindicated in patients with decompensated heart failure, second or third-degree AV blockade, and sick sinus syndrome due to their inhibitory effects on the SA and AV node, slowing cardiac conduction and contractility. 
  • Monitor patients for hypotension, edema, and bradycardia. 
  • Peripheral edema is dose-dependent and may occur within 2 to 3 weeks of initiating calcium channel blocker therapy, particularly dihydropyridines. Peripheral edema due to the redistribution of fluid from the intravascular space to the interstitium. 
  • Diphydroyridines can cause reflex tachycardia and acute hypotension due to their potent vasodilating effects. This effect is more common with first-generation short-acting dihydropyridines (e.g. immediate-release nifedipine) and less with newer agents that are longer acting (e.g. amlodipine). The effect may be lessened by using sustained-release formulations.
  • Diltiazem decreases AV node conduction and heart rate to a lesser extent than verapamil but these drugs should be monitored closely for bradycardia especially with patients on beta-blockers. 
  • Verapamil and diltiazem are considered moderate cytochrome P450 3A4 enzyme inhibitors and should be monitored for drug interactions. 
  • Constipation is a more common side effect with verapamil and occurs to a lesser extent with diltiazem. 

References:

  • McKeever RG, Hamilton RJ. Calcium Channel Blockers. [Updated 2020 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482473/
  • Maclaughlin EJ, Saseen JJ. Hypertension. In: DiPiro JT, Yee GC, Posey L, Haines ST, Nolin TD, Ellingrod V. eds. Pharmacotherapy: A Pathophysiologic Approach, 11e. McGraw-Hill.

Calcium Channel Blockers Read More »

Angiotensin Receptor Neprilysin Inhibitor (ARNI)

Leave a Comment / Uncategorized /

Entresto® 

Angiotensin receptor-neprilysin inhibitors (ARNI) is a new class of heart failure medications. The first drug in this class is Entresto® (sacubitril/valsartan). It is a combination medication comprised of a neprilysin inhibitor (sacubitril) and an angiotensin II receptor blocker (valsartan). 

Mechanism of action: 

To understand the mechanism of action, you must first understand the following biological processes: 

Our body has natural enzymes and hormones that regulate blood pressure and fluid balance.

Natriuretic peptides help maintain sodium and water balance. When this balance is disturbed (say….due to heart failure), levels of natriuretic peptides rise in response to help restore homeostasis. Neprilysin is a naturally occurring enzyme that breaks down natriuretic peptides and prevents them from doing their job. 

Study Tip: Natriuretic sounds like the word diuretic, which is precisely what it is, a ‘natural diuretic’ peptide that helps your body get rid of excess sodium and fluid. Neprilysin ends in ‘-lysin’, hinting that it is an enzyme that lyses or breaks down other substances. 

Angiotensin is a protein hormone that causes vasoconstriction, leading to increased blood pressure and aldosterone synthesis, causing subsequent increases in water retention. 

Study Tip: the prefix ‘angio-‘ means vessel in Greek, so together angiotensin means a hormone that makes your blood vessels tense.

How the medications work (refer to the visual):

  • Sacubitril is a prodrug that inhibits neprilysin thus preventing it from breaking down natriuretic peptides. This mechanism leads to an increase in vasodilation and diuresis as levels of natriuretic peptides rise. 
  • Valsartan directly blocks angiotensin II receptors inhibiting angiotensin II from binding onto the receptors and causing vasoconstriction and aldosterone release.

Indications:

 

  • Reduce the risk of cardiovascular death and hospitalization in patients with chronic heart failure and reduced ejection fraction. 
  • Sacubitril/valsartan is to be used in place of an ACEI or ARB and in conjunction with other standard, heart-failure treatments (e.g., beta blocker, aldosterone antagonist).  

 

Side Effects:


A fun mnemonic to help you remember the side effects is PARCH.

  • Potassium increase
  • Angioedema 
  • Renal Failure
  • Cough
  • Hypotension
 

 Clinical Pearls/Education:

  • If the patient was previously on an ACEI, ensure that they are off of it for 36 hours before initiating sacubitril/valsartan to lower the risk of angioedema.
  • Brain natriuretic peptide (BNP) will not be a reliable marker of heart failure exacerbations in patients taking this drug because sacubitril/valsartan inhibits the breakdown of natriuretic peptide leading to an elevation in BNP.
  • Because neprilysin also breaks down angiotensin II, inhibiting neprilysin will result in an accumulation of angiotensin II. For this reason, a neprilysin inhibitor cannot be used alone; it must always be combined with an ARB (such as valsartan) to block the effect of the excess angiotensin II.
  • The recommended starting dose is sacubitril 49 mg/valsartan 51 mg twice per day. It should be doubled every 2 to 4 weeks as tolerated, up to the target dose of sacubitril 97 mg/valsartan 103 mg orally twice per day.
  • Reduce the starting dose to sacubitril 24 mg/valsartan 26 mg in patients with:
    • Renal impairment (eGFR < 30 mL/min)
    • Moderate hepatic impairment (Child-Pugh class B)
    • Previously on a low dose of on ACEI/ARB or not currently on an ACEI/ARB
  • Administer without regard to meals.
 

References: 

  • Entresto Package Insert (Link)
  • 2021 ACC Heart Failure Guidelines (Link)
  • Nicolas D, Kerndt CC, Reed M. Sacubitril/Valsartan. [Updated 2020 Dec 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. (Link

Check out our FREE Heart Failure Drug Guide here!

Angiotensin Receptor Neprilysin Inhibitor (ARNI) Read More »

Antibiotic: Pharmacology Coloring Book Presale!

Leave a Comment / Uncategorized /

We are excited to release the presale of our first Pharmacology Coloring Book on antibiotics! (Whoohoo!)

Learning antibiotics can be a daunting task, but we aim to make it fun in a creative way. There are so many antibiotics and bacterial organisms to remember and understand. Trust me, I have been there! With matching drugs to bugs to figuring out how to pronounce the names of the antibiotics and bacteria, it can become overwhelming.

We have created this fun coloring book as a supplement to help you learn the material! It has over 30 pages of illustrations, mind maps, humorous mnemonics, and labeling points to test your knowledge! We have also included space for you to incorporate your own notes and doodles! Research have shown that the style of doodle notes can help improve focus, retention, and creativity. 

If you are a visual learner, this coloring book will serve as the perfect supplement during your classes or rotations. 

We are having offering a promotional presale of 25% off. If you order now, you can buy it for $14.99 (originally $19.99) which includes FREE shipping. 

We would love your support! If you think we are doing something great, please share it with your family and friends!

Order Now

Antibiotic: Pharmacology Coloring Book Presale! Read More »

It’s TEST LAUNCH DAY!

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via GIPHY

We could not be more excited for this day to finally arrive. There’s been so much put into getting up to this point. But there’s not much time to celebrate; we’re still hard at work adding new products and features. Keep a lookout. We have even more exciting things to come!

It’s TEST LAUNCH DAY! Read More »

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