@AnKing-Maintainers 7 clozes is a bunch, think we’ve been reticent to change this in the past tho want some more opinions
This one needs to go into slack for proper discussion
Agree with @Sameem - given that this is just a massive list with no memory hook, I could even see argument for 7 clozes
@anking-maintainers thoughts on making this 7 clozes unless anyone has a rock solid mnemonic?
ChatGPT gave me “Be Aware, All Meds Save Hearts” which I thought was clever, though it lacks N for nitrates.
Not sure how good this is but:
“Not MI BASH”
- to contrast “MONA BASH” of MI tx.
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{{c1::Nitrates*::N}}
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{{c1::Mineralocorticoid receptor antagonists::M}}
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{{c1::β-blockers::B}}
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{{c1::ACE inhibitors & ARBs::Ax2}}
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{{c1::SGLT-2 inhibitors (empagliflozin)::S}}
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{{c1::Hydralazine*::H}}
In Extra:
*Hydralazine and nitrates in African American patients
^ How about BASH MAN, includes ARB and ACEi seperately?
Then can split into C1 for BASH and C2 for MAN
BASH MAN is nice
Ideally, we should have a mnemonic with H and N together so we can keep the bit about African American patients in Text. Afaik those two wouldn’t apply to other patient groups so it’d be a bit misleading to not include it in prompt
I tried a lot of diffent combinations but none seem to be catchy. I think it is better if we focus more on concept (RAAS inhibition, anti-adrenergic effect, diuretic effect, and nitrates hydralazine vasodilation), it would be much better. We could just write that in eplaination.
That way we can do c1 for the RAAS ones, ACEi, ARB, mineralocorticoid inhibitors
And c2 on others
@AnKing-Maintainers Did we ever discuss this on Slack? I don’t remember that ever happening. but this suggestion keeps rolling in. We really need to come to some conclusion on it.
Just throwing another option out there:
Myocardial BASH’N
Medications shown to improve long-term survival in patients with LV systolic dysfunction may be remembered with the mnemonic “Myocardial BASH’N”:
{{c1::Mineralocorticoid receptor antagonists}}
{{c1::β-blockers}}
{{c1::ACE inhibitors/ARBs}}
{{c1::SGLT-2 inhibitors (empagliflozin)}}
{{c1::Hydralazine}} and {{c1::Nitrates}} in African American patients
edit: sorry I initially posted just as a reply to Jwill
I’m not sure if I ever saw this in slack being discussed and it seems to still be open so one alternative would be
CHAINSS or SCHAINS (probably SCHAINS is better because it’s too easy to forget the second S)
- Spironolactone
- Carvedilol (β-blocker)
- Hydralazine (vasodilator)
- ACE inhibitors (or ARBs if not tolerated)
- Implantable Cardiac Defibrillator
- Nitrates (vasodilators)
- SGTL2 inhibitor
To my knowledge spironolactone and carvedilol are actually some of the best choices in their respective classes so that works out nicely, but in any case we have other mnemonics that use specific examples from a class to make the mnemonic work. This also adds implantable cardiac defibrillator which is something extra but it’s pretty low-hanging fruit and it makes the mnemonic real nice in my opinion. Could also drop the I entirely and do SCHANS.
The one thing that is missing is that it doesn’t group hydralazine and nitrates, which someone mentioned was potentially desirable. Maybe if there was a way to have I represent hydralazine that could be fixed. I’m not sure if that’s worth it though. To me those stand out as the two vasodilators while everything else hits RAAS in some way or another (among other things).
With SCHAINS having spironolactone first there’s no hint to suggest that over SGTL-2 inhibs. I prefer CHAINSS to keep the 2 S’s together. That way one-by-one format you can just so both S’s one after another so doesn’t really matter which is first if you do them together
I just think whatever we go with needs to have hydralazine and nitrates together.
I second CHAINSS