Carmen chungunco, md fpcp fpcc august 17, 2010 objectives describe the actions of the major classes of diuretics on the formation of urine and the excretion of sodium, potassium, and other cations explain the therapeutic indications, efficacy and side effects of the major classes of diuretics discuss the clinical uses of diuretics. In patients with cirrhosis, start with lowest initial dose and titrate slowly see dosage and administration 2. Spironolactone is a nonselective mineralocorticoid receptor antagonist with moderate affinity for both progesterone and androgen receptors. Spironolactone is a synthetic 17spironolactone corticosteroid with potassiumsparing diuretic, antihypertensive, and antiandrogen activities. Orally administered spironolactone has been shown to be a tumorigen in dietary administration studies performed in rats, with its proliferative effects manifested on endocrine organs and the liver. In fact, the combination of three classes of drugs that affect hemodynamics of the kidney, loop diuretics, angiotensinconverting inhibitors or receptor blockers, and nsaids, is. Aldactone spironolactone is a specific pharmacologic antagonist of aldosterone, acting primarily through competitive binding of receptors at the aldosteronedependent sodiumpotassium exchange site in the distal convoluted renal tubule. Bendroflumethiazide is completely absorbed and uptake from the gastrointestinal tract is not changed by food. Carospir is an oral suspension of spironolactone that received us fda approval in august 2017, developed for patients who cant swallow tablets or have difficulty swallowing. Clinical pharmacology in diuretic use american society of.
It is unknown to what extent, if any, spironolactone may increase actual digoxin exposure. Titrate single daily dose up to ceiling dose as needed thiazide diuretic. Spironolactone has been linked to rare cases of clinically apparent drug induced liver disease. Uses, side effects, interactions, pictures, warnings. The site of action for thiazides is the nacl cotransporter in the distal convoluted tubule of the nephron, which is responsible for around 5% of total sodium reabsorption. Find patient medical information for aldactone oral on webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Spironolacotone and eplerenone are mineralocorticoidblocking agents used for their ability to block both the epithelial and nonepithelial actions of aldosterone. Ppt antiarrhythmic drugs powerpoint presentation free. The drug is used to treat a condition called primary hyperaldosteronism, in which the body. After controlling for predictors of clinical events, spironolactone treatment was associated with a trend for lower risk of mce or heart failure rehospitalization hr, 0. Spironolactone can be taken with or without food, but should be taken consistently with respect to food see clinical pharmacology 12. The latter property increases the likelihood of endocrine side effects with.
Resistant hypertension rhtn is a common clinical problem faced by both primary care clinicians and specialist worldwide. Most diuretics act from the luminal side of the membrane. Spironolactone aldactoner synthetic steroid acts as a competitive antagonist of aldosterone with a slow onset of action, mechanism of action. Its also used to treat high blood pressure and other conditions. Clinical pharmacology notes bioavailability refers to absorption of the drug. Supplemental agents used for secondline therapy and special indications, such as pregnancy and hypertensive emergencies, include angiotensin receptor. Thiazides improve cardiovascular outcomes, including stroke, heart failure, coronary events, and death 36,37. Acts primarily through competitive binding of receptors at the aldosterone dependent sodiumpotassium exchange site in the distal convoluted renal tubule. Despite extensive use of diuretics, for only a few have their pharmacokinetics been evaluated. Emedicine article hypokalemia illustration hotlinked to renal. The clinical benefits of spironolactone as a diuretic are typically not seen until 23 days after dosing begins. Spironolactone description and clinical pharmacology.
Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that todays audiences expect. Chart and diagram slides for powerpoint beautifully designed chart and diagram s for powerpoint with visually stunning graphics and animation effects. Spironolactone competitively inhibits adrenocortical hormone aldosterone activity in the distal renal tubules, myocardium, and vasculature. Dec 15, 2012 despite extensive use of diuretics, for only a few have their pharmacokinetics been evaluated. Pharmacokinetic study of spironolactone 25 mg, 50 mg and 100. Clearance of spironolactone and its metabolites is reduced in patients with cirrhosis. If so, share your ppt presentation slides online with. Clinical pharmacology in diuretic use american society. Causes increased urinary excretion of sodium and water while potassium is retained. Spironolactone, sold under the brand name aldactone among others, is a medication that is. Pharmacokinetics and pharmacodynamics of mineralocorticoid.
Spironolactone is the generic form of the brandname drug aldactone, a prescription diuretic drug. Uses hypertension adjuvant to thiazide, loop diuretics. All but spironolactone must reach the lumen or urinary side of the nephron to exert their effects. Up to two thirds of the drug is eliminated via nonrenal routes. In this situation, a combination of furosemide with spironolactone, in a ratio of 40 mg furosemide to 100 mg. Associate professor pharmacology recommended reading. American society for clinical pharmacology and therapeutics. Comparison of spironolactone, flutamide, and finasteride. As a major modifiable risk factor for cardiovascular disease in this highrisk population, treatment of hypertension in ckd is important. Pharmacokinetic study of spironolactone 25 mg, 50 mg and 100 mg tablets the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. The kidney filters plasma water and solutes at the glomerulus at a very high rate 180 lday and must recover a significant percentage of most of these substances before excretion in the urine. Do not stop taking spironolactone without talking to your doctor. In part 2 the clinical pharmacology of three commonly used.
Winner of the standing ovation award for best powerpoint templates from presentations magazine. Cv pharmacology diuretic agents prepared and presenter. The intent of this study was to identify pharmacokinetic and pharmacodynamic characteristics for spironolactone sp and its metabolites canrenone, 6 betahydroxy7 alphathiomethylspirolactone, 7 alphathiomethylspirolactone in cirrhotics under steady state conditions. Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. Publications home of jama and the specialty journals of.
Thiazide diuretics are the oldest class of antihypertensive drugs still in use. Ckd is common and frequently complicated with hypertension both predialysis and in eskd. Nw newborn drug protocol spironolactone pharmacology. Nine cirrhotics with ascites participated in the study. Clinical use of diuretics in heart failure, cirrhosis, and.
Clinical trial studying the effects of spironolactone on. Spironolactone is a specific pharmacological antagonist of aldosterone. Clinical pharmacology and therapeutics 1985 38, 469474. Diuretics play significant role in pharmacology and treatment options in medicine.
Aldactone causes increased amounts of sodium and water to be. Spironolactone pharmacokinetics and pharmacodynamics in. Clinical pharmacokinetics of diuretics springerlink. In an 18month study using doses of about 50, 150, and 500 mgkgday, there were statistically significant increases in benign. Spironolactone is a specific pharmacologic antagonist of aldosterone, acting primarily through competitive binding of receptors at the aldosteronedependent sodiumpotassium exchange site in the distal convoluted renal tubule. Sep 26, 2005 clinical trial studying the effects of spironolactone on heart and skeletal muscle function in chronic alcoholics spica the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. New insights into the pharmacokinetics of spironolactone. Carospir suspension fda prescribing information, side. Clinical trial studying the effects of spironolactone on heart and skeletal muscle function in chronic alcoholics spica the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Patients who tolerate 25 mg once daily may have their dosage. Our new crystalgraphics chart and diagram slides for powerpoint is a collection of over impressively designed datadriven chart and editable diagram s guaranteed to impress any audience. Pharmacology of diuretics free download as powerpoint presentation. Download figure open in new tab download powerpoint.
Clinical pharmacology of antihypertensive therapy for the. Based on the endocrine society clinical practice guideline on the evaluation and treatment of hirsutism in premenopausal women, spironolactone is effective and may be considered among other antiandrogens in the management of this condition. Spironolactone is an orally active, potassiumsparing diuretic, which works by antagonising the effects of aldosterone at renal mineralocorticoid receptors. Spironolactone may be considered for initial therapy, either as monotherapy in women who are not at risk. Spironolactone controls high blood pressure, edema, heart failure, and hyperaldosteronism but does not cure these conditions. The present study is the first to evaluate the efficacy on hirsutism of three different drugs, spironolactone, flutamide, and finasteride, by a rigorous clinical trial methodology of a double blind, placebocontrolled, randomized study. The clinical consequence of these effects is evident in the association between recent use of nsaids and risk for hospitalization in patients with heart failure. It is defined as blood pressure bp that remains above the goal, despite the concurrent use of 3 antihypertensive agents of different classes prescribed at optimal dosage. Aldactone spironolactone is a specific pharmacologic antagonist of aldosterone, acting. Spironolactone was prescribed to 279 58% patients and mean followup was 1029 days. Increased gastric emptying and induction of liver enzymes increases first pass metabolism and reduced bioavailability. Heart failure pharmacology maureen schaupp, msn, cnp, chfn. Spironolactone, tablet, 25 mg1, oral, contract pharmacy services pa, 20100802, not applicable, us us. Listing a study does not mean it has been evaluated by the u.
Ppt antihypertensive drugs clinical pharmacology of oral antihypertensive drugs powerpoint presentation free to download id. In patients taking concomitant digoxin, use an assay that does not interact with spironolactone. It may take about 2 weeks or longer before the full effect of spironolactone occurs. Topics of discussion introduction basic concepts pharmacology diuretic use in syndromes clinical trials diuretic resistance conclusion. Used in the treatment of lowrenin hypertension, hypokalemia and conns syndrome. The adobe flash plugin is needed to view this content. Spironolactone and its active metabolites are specific pharmacologic antagonists of aldosterone, acting primarily through competitive binding of receptors at the aldosteronedependent sodiumpotassium exchange site in the distal convoluted renal tubule. Individuals receiving maintenance dialysis therapy have extraordinarily high rates of cardiovascular cv death1 and an absence of effective datadriven therapies capable of mitigating cv risks. Pharmacology of diuretics authorstream presentation. Crcl 50, use 25 to 50 mgd hctz crcl 20 to 50, use 50 to 100 mgd hctz crcl download fulltext pdf. The clinical utility of mra in stable patients with heart failure and reduced lvef was first demonstrated in the randomized aldactone evaluation study rales in 1991. Crcl 50, use 25 to 50 mgd hctz crcl 20 to 50, use 50 to 100 mgd hctz crcl 75. Ppt antihypertensive drugs clinical pharmacology of oral. Mineralocorticoid receptor antagonists journal of endocrinology.
To know the principles of treatment it is essential to understand the underlying pathophysiological mechanisms that cause the need. Pharmacokinetic study of spironolactone 25 mg, 50 mg and. Topics of discussion introduction basic concepts pharmacology diuretic use in. Spironolactone, a 17spirolactone figure 4, is a synthetic steroid that is an aldosterone competitive antagonist. Because the mechanisms for reabsorption of salt and water differ in. The major transport mechanisms for the recovery of ions and water in the various segments of the nephron are shown in figure 151. Ppt cardiac pharmacology powerpoint presentation free. Dailymed spironolactone and hydrochlorothiazide tablet. This presentation was used for theory class of mbbs sem iii.
Spironolactone causes increased amounts of sodium and water to be excreted, while potassium. The steroid structure of spironolactone means that it has the potential to cause gynaecomastia and hirsutism among other steroid. The diuretics in our therapeutic armamentarium have predictable effects based on their nephron sites of action. This agent may inhibit the pathophysiologic effects of aldosterone produced in excess by various types of.
Spironolactone is also frequently used in medical gender transition. Spironolactone fda prescribing information, side effects. Antihypertensive drugs clinical pharmacology of oral antihypertensive drugs is the property of its rightful owner. The latter property increases the likelihood of endocrine side effects with spironolactone.
Continue to take spironolactone even if you feel well. The wide variety of firstline agents available for managing high blood pressure include diuretics, beta adrenergic receptor blockers, alpha adrenergic receptor blockers, angiotensin converting enzyme inhibitors, and calcium channel blockers. Spironolactone oral tablet is a prescription medication used to reduce swelling caused by fluid buildup in your tissues. Pt denotes those abstracts submitted by trainees that were selected to receive presidential trainee awards. Chronic renal failure nephrotic syndrome cirrhosis mild chf moderate or severe chf loop diuretic. Potency refers to the amount of drug usually needed to produce an effect, such as relief of pain or reduction of blood pressure. Increase the urine flow, change urine ph change the ionic composition of the urine and blood. Indications, dose, contraindications, sideeffects, interactions, cautions, warnings and other safety information for spironolactone. Dec 05, 2018 clinical pharmacology mechanism of action. An exception is the aldosterone receptor antagonist group eg, spironolactone and eplerenone.