Visual Summary

SGLT2 Inhibitors and Additional Agents

Module 5 — Introduction to Medical Pharmacology

Four Additional Agents

Fourth Pillar

SGLT2 Inhibitors

  • Mild osmotic diuresis from glucose and sodium loss in the urine
  • First class proven in heart failure with preserved ejection fraction
  • Used regardless of diabetes status

For Worsening Disease

Vericiguat

  • Directly stimulates the nitric oxide pathway enzyme
  • Works even when nitric oxide is depleted
  • Added when patients worsen despite the four pillars

RAAS-Independent Vasodilator

Hydralazine / Isosorbide Dinitrate

  • Combines arterial and venous vasodilation
  • Alternative when RAAS blockade is not possible
  • Proven mortality benefit in self-identified Black patients

Heart Rate Control Without Negative Inotropy

Ivabradine

  • Slows the sinoatrial node directly
  • Does not work in atrial fibrillation
  • Characteristic side effect: visual phosphenes