Rx Note

Introduction The treatment approach for type 2 diabetes mellitus has undergo a shift from the traditional glucose-centric approach to the new cardiorenal-metabolic approach. This change emphasizes a comprehensive approach for reducing the risk of diabetes-related complications. As a result of this shift, sodium glucose co-transporter 2 (SGLT-2) inhibitors, such as canagliflozin, dapagliflozin and empagliflozin, have emerged as a key player for managing type 2 diabetes. Mechanism of Action The SGLT-2 inhibitors act by promoting the glucose excretion into the urine, thereby reducing the concentration of circulating glucose. The resulting glycosuria is associated with an osmotic diuresis and salt excretion. Furthermore, the osmotic diuretic effect and the caloric loss (from glucose in the urine) also leads to reduction in systolic blood pressure and body weight. Expected Benefits Lower blood glucose. 0.3-1.0% reduction in HbA1c Effect on both fasting and postprandial glucose concentratio...

Introduction Graduating from university is not the ending of learning, but the beginning of self- learning . Never in my university years, I have heard of the term ARNI (angiotensin-receptor nerilysin inhibitors). An example of it is Entresto, which consists of sacubitril and valsartan in a fixed combination. Valsartan, in formulation, is more bioavailable than other tablet formulations; 26 mg, 51 mg and 103 mg valsartan is equivalent to 40 mg, 80 mg and 160 mg respectively. Entresto is a novel therapy recommended for patients with Chronic heart failure with reduced ejection fraction (HFrEF) to reduce morbidity and mortality Essential hypertension What Benefits does Entresto Offer over ACEI in Heart Failure? A randomized double-blind trial ( PARADIGM-HF ) in patients with HFrEF found that sacubitril-valsartan (Entresto) reduced all-cause mortality as well as cardiovascular mortality and hospitalization for HF compared with a proven dose of the ACE inhibitor enalapril. How about Safe...

Introduction Heart failure is not a single pathological diagnosis, but a clinical syndrome consisting of cardinal symptoms (e.g. breathlessness, ankle swelling and fatigue ) that may be accompanied by signs (e.g. elevated jugular venous pressure, pulmonary crackles, and peripheral oedema ). It is due to a structural and/or functional abnormality of the heart that results in elevated intracardiac pressures and/or inadequate cardiac output at rest and/or during exercise . The median survival following a diagnosis is around 3 to 5 years. A commonly used classification is by left ventricular ejection fraction (LVEF). HFrEF - Heart failure with reduced ventricular ejection fraction (i.e.≤ 40%) HFmrEF - Heart failure with mildly reduced ventricular ejection fraction (i.e. 41-49%) HFpEF - Heart failure with preserved ventricular ejection fraction (i.e. ≥50%) New York Heart Association (NYHA) Functional Classification The simplest terminology used to describe the severity of HF is the NYHA fun...