The Annals of pharmacotherapy
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A recent meta-analysis demonstrated that angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) reduce the incidence of new-onset atrial fibrillation by nearly 50%. However, the ability of ACE inhibitors or ARBs to prevent post-cardiothoracic surgery (CTS) atrial fibrillation, when used postoperatively, has yet to be evaluated. ⋯ In this evaluation, postoperative ACE inhibitor or ARB use was not associated with a reduction in post-CTS atrial fibrillation. A study of preoperative, longer-term ACE inhibitor and/or ARB therapy is needed to determine the benefits of that strategy.
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Randomized Controlled Trial Comparative Study
Perioperative nesiritide versus milrinone in high-risk coronary artery bypass graft patients.
Patients with left-ventricular dysfunction have an increased risk of developing heart failure after coronary artery bypass graft (CABG) surgery. Therapies to maintain cardiac output in such patients warrant investigation. Nesiritide is unique among intravenous medications used to manage heart failure. It mediates natriuresis and vasodilation and suppresses the reninangiotensin-aldosterone axis. Nesiritide may attenuate the body's neurohormonal response to myocardial stretch after CABG and provide clinical benefit in the immediate postoperative period. ⋯ Nesiritide does not decrease postoperative intensive care unit stay or other clinical parameters compared with milrinone in high-risk patients with hemodynamically stable left-ventricular function undergoing CABG surgery.
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Are you a "spiritual" pharmacist? I define being spiritual as having an ongoing relationship with God regardless of whether one is physically healthy, "stressed out," or sick; I encourage pharmacists to pray for, and with, their patients when opportunities present themselves and patients are receptive. Spiritual healing can be as dramatic as physical and emotional healing. ⋯ Imagine office-based and hospital employees, from accounting, to housekeeping, to pharmacy, to nurses and physicians, praying daily. Many patients and their healthcare providers believe that faith-based prayers to God are important instruments for healing, and spiritual pharmacists may wish to consider integrating prayer into their professional practice.