Rational pharmacotherapy of cardiovascular diseases and pharmacosafety in cardiology

Course curriculum

• General principles of rational pharmacotherapy of cardiovascular diseases
• Principles of rational pharmacotherapy of cardiovascular diseases. (Rational pharmacotherapy: the WHO definition. The modern concept of rational use of medicines)
• Clinical aspects of pharmacodynamics (Mechanism of action of drugs. Effects of drugs upon repeated administration. Factors determining individual sensitivity to drugs. Criteria for the clinical efficacy of drugs)
• Clinical aspects of pharmacokinetics (Pharmacokinetics: main processes. Cytochrome P450. The role of cytochrome P450 isoenzymes in drug biotransformation. Drug interactions. Pharmacokinetic drug interactions at the level of cytochromes)
• Assessment of drug efficacy from the perspective of evidence-based medicine: principles, types of clinical trials, hierarchy of evidence (levels of evidence). Classes of recommendations. (Drug interactions. Types of clinical trials. Hierarchy of scientific evidence. Classes of recommendations and levels of evidence.)
• Drug safety. Adverse effects of drugs. Adverse drug reactions: classification, types, incidence rate (Drug safety. Criteria for the "drug-adverse reaction" relationship. Drug safety. Serious adverse reactions. Adverse reactions: classification by frequency. Types of adverse reactions to drugs)
• Contraindications to prescribing medicines. Safety monitoring of drug therapy and the pharmacovigilance system (Safety rules to avoid adverse effects. Monitoring of adverse reactions. What to report to the pharmacovigilance service? Notification of an adverse reaction or lack of therapeutic effect of a medicinal product.)
• Drug equivalence. Original and reproduced (generic) medicinal products
• The concept of class effect. The problem of drug substitution. (General issues related to drug selection. Drug class selection. Selection and substitution of drugs within a class. Key pharmacokinetic characteristics of ACE inhibitors. Non-inferiority and equivalence studies.)
• Practical analysis of assessing validity and interpreting the results of clinical trials using the example of trials conducted in cardiology. (What do you need to know for the competent use of medications in a patient with cardiovascular disease? Is the study valid (methodologically sound)? The JUPITER trial: the efficacy of ROSUVASTATIN in the prevention of cardiovascular events)
• Antithrombotic therapy
• Antithrombotic agents. (Hemostasis. Stages. Physiology of the blood coagulation system. Classification of antiplatelet agents. Antithrombotic therapy in patients with chronic CS: antiplatelet agents and anticoagulants. Physiology of the blood coagulation system)
• Antithrombotic therapy in coronary artery disease. Patients after ACS. Antithrombotic therapy in patients with chronic CAD. Recommendations for patients with chronic coronary syndrome and sinus rhythm. Antithrombotic therapy after PCI in patients with chronic CAD and sinus rhythm. Antithrombotic therapy in patients with chronic CAD and atrial fibrillation. Antithrombotic therapy after PCI in patients with AF. Dual antiplatelet therapy in patients with chronic CAD and high or moderate risk of ischemic events. Intensification of antithrombotic therapy in patients with CCS and sinus rhythm
• Antithrombotic therapy in cerebrovascular disease. (Recommendations for patients with cerebrovascular diseases)
• Antithrombotic therapy in peripheral atherosclerosis (ASA monotherapy, clopidogrel monotherapy)
• Antithrombotic therapy in atrial fibrillation. (Antithrombotic therapy in non-valvular atrial fibrillation. CHA2DS2-VASc score. Antithrombotic therapy in non-valvular AF. Clinical risk factors per the HAS-BLED score. The TFN practical algorithm for assessing and modifying minor bleeding risk factors in AF patients receiving DOAC therapy. Renal function monitoring in AF patients. Antithrombotic therapy in valvular atrial fibrillation)
• Prevention of cardioembolic complications in patients with heart valve defects or prosthetic valves
• Prevention and treatment of deep vein thrombosis of the lower limbs. (Recommendations on the regimen and duration of anticoagulant therapy after pulmonary embolism in patients with active oncological diseases)
• Strategy for reducing the risk of hemorrhagic complications
• Practical analysis of algorithms for escalating and de-escalating antiplatelet therapy (Algorithms for escalating and de-escalating antiplatelet therapy.)
• Practical analysis of algorithms for discontinuing direct oral anticoagulants before elective surgery. (Algorithm for discontinuing direct oral anticoagulants before elective surgery. Classification of elective surgical procedures by bleeding risk. Algorithm for discontinuing antiplatelet agents before surgery)
• Pharmacotherapy of arterial hypertension
• Clinical aspects of arterial hypertension (AH). Cardiovascular risk assessment. (Arterial hypertension: definition. Basic concepts. Arterial hypertension: classification. Arterial hypertension: etiology and pathogenesis. Classification of office BP levels and degrees of essential (primary) AH. Definition of arterial hypertension by office, ambulatory and home blood pressure measurement. Factors determining cardiovascular risk and disease stage in patients with AH. Risk stratification. Arterial hypertension: overview of clinical guidelines)
• Treatment strategy for patients with arterial hypertension: general management principles. (Non-pharmacological treatment of arterial hypertension. General principles of managing patients with arterial hypertension: three important aspects. Initiation of antihypertensive therapy at various blood pressure values. Indications for initiating antihypertensive therapy depending on age and comorbidities. 2023 ESH Guidelines: initiation of antihypertensive therapy at various blood pressure values. Target blood pressure levels. 2023 ESH Guidelines: target blood pressure in patient groups aged 18-64 and 65-79 years. 2023 ESH Guidelines: target blood pressure in patients over 80 years of age. Initiation of antihypertensive therapy at various blood pressure values)
• Drug treatment of patients with AH. (General recommendations for treatment with antihypertensive drugs)
• Main classes of antihypertensive drugs. (The renin-angiotensin-aldosterone system (RAAS) and the cardiovascular continuum. RAAS blockade: ACE inhibitors (ACEIs) and ARBs. Main pharmacokinetic characteristics of ACEIs (after L.H. Opie with modifications). RAAS blockers: ACE inhibitors (ACEIs) and TOD. Main classes of AHDs for treating patients with AH: ACEIs. Contraindications and conditions requiring a cautious approach for AHDs. Comparative characteristics of ARBs. T/P index (trough/peak). Comparative characteristics of ARBs. Main classes of AHDs for treating patients with AH: ARBs. Contraindications and conditions requiring a cautious approach for AHDs. General treatment recommendations. Thiazide and thiazide-like diuretics. Calcium channel blockers. Contraindications and conditions requiring a cautious approach for AHDs. Beta-blockers.)
• Additional classes of antihypertensive drugs (mineralocorticoid receptor antagonists (MRA). Aldosterone: role in pathogenesis. Mineralocorticoid receptor antagonists. Contraindications and conditions requiring a cautious approach for antihypertensive drugs. Alpha-blockers. Imidazoline receptor agonists.)
• Algorithm for selecting antihypertensive drugs. (description of the algorithm for various combinations)
• Treatment of resistant arterial hypertension. Treatment adherence. (Criteria. Uncontrolled HTN. Resistant HTN: criteria. Causes of pseudoresistance. Patient characteristics that should raise suspicion of secondary hypertension. Secondary HTN. Incidence of secondary hypertension forms by age. Strategy for lowering BP in true resistant HTN)
• Hypertensive crisis. Pharmacotherapy of conditions requiring immediate blood pressure reduction. (Emergency conditions in arterial hypertension: hypertensive crisis. Hypertensive crisis: rate of BP reduction. Drugs for the treatment of HC. Emergency conditions requiring immediate BP reduction with intravenous drug therapy)
• Practical analysis of pharmacotherapy in patients with arterial hypertension in the presence of concomitant risk factors. (Factors determining cardiovascular risk and disease stage in patients with arterial hypertension. Initiation of antihypertensive therapy at different blood pressure values. Target blood pressure levels. Lipid modification to reduce cardiovascular risk. Treatment of concomitant risk factors.)
• Practical analysis of the pharmacotherapy of a patient with resistant arterial hypertension. Recommendations for the long-term management of patients with arterial hypertension. (Portraits of ARTERIAL HYPERTENSION. Adherence: terminology. Patients with arterial hypertension have one of the lowest levels of adherence among different therapeutic profiles. Methods of assessing adherence. Assessing ADHERENCE using QUESTIONNAIRES. Comparative characteristics of questionnaires. The Morisky-Green test (MMAS-4) for assessing adherence
• Pharmacotherapy of arterial hypertension in specific categories of patients
• Features of antihypertensive therapy in elderly and senile patients taking into account functional status and the presence of geriatric syndromes. (Indications for initiating antihypertensive therapy depending on age and comorbidities. 2023 ESH Recommendations: initiation of antihypertensive therapy at various BP values. Target BP levels. 2023 ESH Recommendations: target BP in patient groups aged 18-64 and 65-79 years. 2023 ESH Recommendations: target. Algorithm of antihypertensive therapy. General recommendations for treatment with antihypertensive drugs.)
• Features of antihypertensive therapy in women. Treatment of arterial hypertension during pregnancy and in the postpartum period. (Facts and reality about CVD in women. Differences between men and women. Arterial hypertension in pregnant women. Treatment of AH during pregnancy. Prevention of AH and preeclampsia in pregnant women. Antihypertensive therapy in the postpartum period. Pregnancy and cardiovascular risk. Sex-associated risk factors for cardiovascular disease in women. Common symptoms of elevated BP in young and middle-aged women (ESC, 2019).)
• Antihypertensive therapy in women of reproductive age. (Cardiovascular disease risk factors in women. Metabolic risk factors in women. Antihypertensive therapy in women of reproductive age)
• Pharmacotherapy of arterial hypertension in patients with heart and vascular diseases (coronary heart disease, valvular diseases, aortopathies, rhythm disorders, atherosclerosis of the carotid and peripheral arteries). (Contraception and cardiovascular disease risk. The relationship between menopause and cardiovascular disease. Protective effects of endogenous estrogens. Features of arterial hypertension in women during peri- and postmenopause. Menopause and cardiovascular disease risk. Premature ovarian insufficiency. Menopause and hormone therapy