Aldosterone Antagonist Hf Tx

Front 1

What are the aldosterone antagonists?

Back 1

spironolactone (Aldactone) and eplerenone (Inspra)

Front 2

How do the aldosterone antagonists work?

Back 2

block the mineralocorticoid receptor, the target site for aldosterone
inhibit Na reabsorption and K excretion in the kidney
heart: inhibit cardiac extracellular matrix and collagen deposition, thereby attenuating cardiac fibrosis and ventricular remodeling

Front 3

What AE for spironolactone (Aldactone)?

Back 3

gynecomastia and other sexual SE because interacts with androgen and progesterone receptors
less frequent with eplerenone

Front 4

Why does eplerenone(Inspra) have less gynecomastia?

Back 4

low affinity for the progesterone and androgen receptors

Front 5

Are the benefits of aldosterone antagonists in HF only a result of the inhibition of aldosterone's actions in the heart resulting in inhibition of aldosterone mediated cardiac fibrosis and ventricular remodeling?

Back 5

no

Front 6

What major AE from aldosterone antagonists?

Back 6

hyperkalemia

Front 7

What factors contribute to high rate of hyperkalemia from aldosterone antagonists?

Back 7

initiation of aldosterone antagonists in pts with impaired renal function or high K concentrations and failure to decrease or stop K supplements when starting
others: diabetes, old, inadequate lab monitoring, concomitant high dose ACEI, BB, NSAIDs, or COX2 inhibitors

Front 8

What is the main recommendation to avoid hyperkalemia with aldosterone antagonist?

Back 8

avoid in pts with renal dysfunction

Front 9

How is estimate of renal function affected by serum Cr in elderly and pts with decreased muscle mass?

Back 9

overestimated

Front 10

What effect do BB have on RAAS system?

Back 10

inhibit plasma renin release and may provide additional suppression of RAAS when used with ACEI

Front 11

When is it recommeded to use aldosterone antagonist?

Back 11

add to standard therapy in select pts provided K and renal function can be carefully monitored
Pts: moderately severe to severe HF who are receiving standard tx and those with LV dysfunction early after MI

Front 12

When else might aldosterone antagonists be beneficial?

Back 12

class I-III HF in pts who require K supplementation
might be possible to reduce or eliminate K while potentially providing additional benefit

Front 13

When should aldosterone antagonists be avoided?

Back 13

serum Cr greater than 2.0 in women and 2.5 in men or CrCl less than 30mL/min, recent worsening of renal function, serum K 5meq/L or more, history of severe hyperkalemia

Front 14

When should low doses of aldosterone antagonists be especially used?

Back 14

elderly, DM, or CrCl less than 50mL/min

Front 15

What meds should be avoided with aldosterone antagonists to avoid hyperkalemia?

Back 15

NSAIDs, COX-2 inhibitors, high dose ACEI or ARB, triple therapy with ACEI/ARB/aldosterone antagonist

Front 16

How often should K and renal function be monitored with aldosterone antagonists?

Back 16

within 3 days and 1 week after initiation or dose titration, thereafter monthly for 3 months and then every 3 months

Front 17

What K level should aldosterone antagonist be d/c?

Back 17

greater than 5.5mg/dL