Pharmacotherapeutics

Drugs n classification's.

Here you will find all classification of drugs

FDA Approves Entresto for Heart Failure Treatment

The FDA has approved sacubitril/valsartan (Entresto, Novartis) to treat heart failure (HF) with reduced ejection fraction.


The new oral drug is indicated for patients whose condition is classified New York Heart Association (NYHA) class II-IV to reduce the risk for cardiovascular death and hospitalizations due to HF. Entresto will replace an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker, but will typically be used with other HF therapies.

“Heart failure is a leading cause of death and disability in adults,” said Norman Stockbridge, MD, PhD, the director of the Division of Cardiovascular and Renal Products in the FDA’s Center for Drug Evaluation and Research. “Treatment can help people with heart failure live longer and enjoy more active lives.”

In granting approval, the FDA considered the results from the 8,442-patient PARADIGM-HF study, which was stopped early when it was shown that Entresto significantly reduced the risk for cardiovascular death compared with the ACE inhibitor enalapril (N Engl J Med 2014;371[11]:993-1004). Most patients were also receiving β-blockers, diuretics and mineralocorticoid antagonists. Patients with reduced ejection fraction also experienced fewer hospitalizations due to HF. In the study, Entresto:
reduced the risk for death from cardiovascular causes by 20%;
reduced HF hospitalizations by 21%; and
reduced the risk for all-cause mortality by 16%.
Overall, there was a 20% risk reduction on the primary end point, a composite measure of cardiovascular death or time to first HF hospitalization.

Entresto is part of a new class of drug, called angiotensin receptor neprilysin inhibitors, which reduce the strain on the failing heart. Taken orally twice daily, it acts to enhance the protective neurohormonal systems of the heart while simultaneously suppressing the harmful renin-angiotensin-aldosterone system, which promotes left ventricular remodeling and contributes to left ventricular HF.

“The very meaningful survival advantage of Entresto seen in the PARADIGM-HF trial should persuade physicians to consider Entresto for all appropriate patients, in place of traditional ACE inhibitors or angiotensin receptor blockers,” said Milton Packer, MD, a professor and the chair of the Department of Clinical Sciences at the University of Texas Southwestern Medical Center, in Dallas.

An estimated 5.1 million individuals in the United States suffer from HF and about half have reduced ejection fraction. About 2.2 million of these individuals have NYHA class II-IV HF, based on how much their symptoms limit their physical activity. HF is a debilitating, life-threatening condition in which the heart cannot sufficiently pump blood around the body. Patients with HF face a high risk for death, repeated hospitalizations and symptoms such as breathlessness, fatigue and fluid retention, significantly decreasing quality of life.

The most common side effects of Entresto were hypotension, hyperkalemia and renal impairment. Angioedema was also reported; black patients and those with a prior history of angioedema have a higher risk. Patients should be advised to get emergency medical care immediately if they have symptoms of angioedema or trouble breathing while taking Entresto. Health care professionals should advise patients not to use Entresto with any drug from the ACE inhibitor class because of an increased risk for angioedema. When switching between Entresto and an ACE inhibitor, there should be a 36-hour washout period.

There is a possible risk for fetal harm, so Entresto should be discontinued in pregnant women.

Novartis said it would begin shipping Entresto next week.

Severity Classification in Patients With Asthma Who Have Not Initiated Treatment

Asthma Control Classification in Patients With Asthma Who Have Initiated Treatment

Spirometric Classification of COPD Severity Based on Postbronchodilator FEV1

Difference Between Asthma and COPD and Its Pharmacotherapy.

Recent advances in pharmacotherapy of glaucoma

Glaucoma is a slow progressive degeneration of the retinal ganglion cells (RGCs) and the optic nerve axons, leading to irreversible blindness if left undiagnosed and untreated. Although increased intraocular pressure is a major risk factor of glaucoma, other factors include increased glutamate levels, alterations in nitric oxide (NO) metabolism, vascular alterations and oxidative damage caused by reactive oxygen species. Glaucoma is the second leading cause of blindness globally, accounting for 12.3% of the total blindness. Glaucoma has been broadly classified as primary or secondary open-angle or angle-closure glaucoma. The primary goal in management of glaucoma is to prevent the risk factor, especially elevated intraocular pressure (IOP), using medications, laser therapy or conventional surgery. The first-line treatment of glaucoma usually begins with the use of a topical selective or nonselective blocker or a prostaglandin analog. Second-line drugs of choice include alpha-agonists and topical carbonic anhydrase inhibitors. Cholinergic agonists are considered third-line treatment options. When a single therapy is not sufficient to lower the IOP, a combination therapy is indicated. To enhance the patient compliance, drug delivery systems like electronic devices, ocular inserts, tansdermal and mechanical drug delivery systems have been developed. Use of viscoelastic agents in ophthalmic formulations, emulsions and soluble ophthalmic drug inserts (SODI) enhance patience compliance and ocular drug delivery in patients in long-term glaucoma therapy. For patients who do not respond to antiglaucoma medications, laser trabeculoplasty and incisional surgery are recommended. Several nutrients and botanicals hold promise for the treatment of glaucoma, but most studies are preliminary, and larger, controlled studies are required. Future directions for the development of a novel therapy glaucoma may target glutamate inhibition, NMDA receptor blockade, exogenously applied neurotrophins, open channel blockers, antioxidants, protease inhibitors and gene therapy.

Blood Pressure Chart and Classification

Antibiotic Classification

Intralesional therapy for metastatic melanoma

Intralesional therapy for metastatic melanoma has some advantages over systemic therapy. Local drug administration allows for delivery of an increased concentration of the agent and reduced systemic exposure, thereby increasing local efficacy and limiting toxicity. Moreover, since in vivo tumor nodules contain the tumor antigens, this tumor tissue may serve as an autologous vaccine to induce systemic immunity. This so-called 'bystander effect', where uninjected distant lesions exhibit a response, has been reported in select intralesional therapy trials. Areas covered: This review will give an overview of the working mechanisms, clinical evidence and side effects for available intralesional and topical therapies and summarize the most recent developments in this field. Expert opinion: The ideal treatment approach for locoregionally advanced melanoma should be multidisciplinary and tailored to the patient, taking into consideration patient-related, tumor-related factors (such as location, tumor burden, mutation status) and previous treatments received. It will likely not be a single therapy, but rather a combination of injectable treatments, regional perfusions and systemic therapies.

Management of diabetes in the elderly with
canagliflozin: A newer hypoglycemic drug on the
horizon

Canagliflozin is the first available oral inhibitor of sodium/glucose cotransporter 2 (SGLT2) in the market. At
the outset it sounds excellent for the use in the elderly diabetic population, because of its minimal tendency
to cause hypoglycemia. However, the clinician needs to exercise caution as it needs to be dosed renally. The
clinician needs to be circumspect about potential drug interactions, especially when there is an underlying
chronic kidney disease (CKD) and congestive heart failure (CHF). Also its use is best avoided in people who
are predisposed to ge***al mycotic and urinary tract infections (UTI).