This second article focuses on safe and effective prescribing of medications which will reduce risk of further cardiovascular events. This series provides a 'hands on' practical guide to conducting medication reviews of long-term cardiovascular conditions. In this issue, we look at how to ensure post-myocardial infarction patients are taking the right medications at the right doses to ensure they get maximum benefit.
Angina is on the increase as people live longer. It is the most common symptom of ischaemic heart disease and occurs when the arteries are no longer able to supply the heart with enough blood to meet its demands. Treatment aims to restore the balance between oxygen supply and demand, to relieve the pain as quickly as possible and prevent further angina attacks, to treat the risk factors, limit the progression of coronary artery disease and reduce the risk of a heart attack. Procoralan (ivabradine) works by specifically inhibiting the If or 'funny' channel in the sinoatrial node of the heart (also known as the cardiac pacemaker) to reduce the resting heart rate, matching the efficacy of beta-blockers without their side-effects.
Insulin pumps – small devices that deliver insulin at regular intervals and on demand – are proving increasingly popular with patients with type 1 diabetes who find their glucose levels difficult to control with injections or who have other complications. They can offer significant benefits in terms of overall glucose control and patient's quality of life. In this article we review how insulin pumps have developed over the last 40 years, how modern pumps are used, which patients should be considered for their use and cost issues associated with these devices.
A new fixed dose combination of saxagliptin (Onglyza) and dapagliflozin (Forxiga) is now available for use in adults with type 2 diabetes.
Volume 13, Special Issue 1, Oct-Nov-Dec 2016
Commissioning is not so different from seeing patients. As a GP you listen, examine, draw up a diagnosis and plan treatment. In commissioning, the community served by the clinical commissioning group (CCG) is the ‘patient’. When considering the introduction of a new treatment for heart failure (HF) such as sacubitril/valsartan (Entresto), we must consider not only its acquisition costs but also its potential benefits in improving patients' symptoms and reducing expensive hospital admissions.
Sacubitril/valsartan (Entresto), the first angiotensin receptor-neprilysin inhibitor (ARNI), is a recently licensed medication that has been shown to improve outcomes for patients with symptomatic chronic HF with reduced ejection fraction (HF-REF) compared with current gold-standard treatment with an ACE inhibitor. This article describes the pharmacist’s role in supporting patients receiving sacubitril/valsartan.
Many patients with heart failure rely on practice nurses to monitor their care. A multidisciplinary team (MDT) integrated community approach has been endorsed by NICE guidelines when delivering HF care. This article provides practice nurses with the information they need to understand the condition, current treatment guidelines, and the new treatment – sacubitril/valsartan, the first-in-class angiotensin receptor-neprilysin inhibitor.