Presentation is loading. Please wait.

Presentation is loading. Please wait.

Spironolactone: An Old Friend Rediscovered Domenic A. Sica MD The Journal of Clinical Hypertension Volume 8, Issue 7, Volume 8, Issue 7, pages 467–469,

Similar presentations


Presentation on theme: "Spironolactone: An Old Friend Rediscovered Domenic A. Sica MD The Journal of Clinical Hypertension Volume 8, Issue 7, Volume 8, Issue 7, pages 467–469,"— Presentation transcript:

1

2 Spironolactone: An Old Friend Rediscovered Domenic A. Sica MD The Journal of Clinical Hypertension Volume 8, Issue 7, Volume 8, Issue 7, pages 467–469, July 2006

3 FOUR CARDIAC MEDICINES DEVELOPED BEFORE 1960 THAT SURVIVED THE TURN OF THE MILLENNIUM ARE ASPIRIN, DIGOXIN, WARFARIN, AND SPIRONOLACTONE.

4

5

6

7

8

9

10

11

12

13

14 DNN 2008A MAGAS SZÉRUM KÁLIUM EREDETE ÉS KÖVETKEZMÉNYEI 14

15

16

17

18

19

20 Table. Comparison of the Package Labels for Spironolactone and Eplerenone EPLERENONESPIRONOLACTONE Contraindicated with a serum potassium of >5.5 mEq/L Spironolactone is contraindicated in patients with hyperkalemia with no statement as to what qualifies as hyperkalemia. CONTRAINDICATED IN TYPE 2 DIABETES WITH MICROALBUMINURIA No comment Contraindicated with a serum creatinine of >2.0 mg/dL in men or 1.8 mg/dL in women Spironolactone is contraindicated in patients with anuria, acute renal insufficiency, significant impairment of renal excretory function with no qualification as to the specific level of renal function where it would be contraindicated. Contraindicated with a creatinine clearance of <50 mL/min Spironolactone is contraindicated in patients with anuria, acute renal insufficiency, significant impairment of renal excretory function with no qualification as to the specific level of renal function where it would be contraindicated. Contraindicated in patients treated concomitantly with potassium supplements or other potassium- sparing diuretics The following is provided as a “Warning” but not a contraindication: potassium supplementation, either in the form of medication or a diet rich in potassium, should not ordinarily be given in association with spironolactone. Spironolactone should not be administered concurrently with other potassium-sparing diuretics. C ontraindicated with strong inhibitors of CYP450 3A4 such as ketoconazole or itraconazole Not dependent on the CYP450 system for metabolism

21 Megegyeznek a szerzők, hogy van egy „mentsvár” a hyperkalaemiás komplikációk lehetséges elkerülésére (már akkor, ha a szabályokat egyébként betartják, és például lehetőleg elkerülik, hogy 45 ml/min GFR alatt adjanak AA-t a betegnek), és ez a diuretikum bevétele a kombinációba.

22 Conclusions BLOCKADE OF ALDOSTERONE RECEPTORS BY SPIRONOLACTONE, IN ADDITION TO STANDARD THERAPY SUBSTANTIALLY REDUCES THE RISK OF BOTH MORBIDITY AND DEATH AMONG PATIENTS WITH SEVERE HEART FAILURE. (N Engl J Med 1999:341: )

23

24 SPIRONOLACTONE SPIRONOLACTONE (12.5–50 mg/d) was added to a regimen including a diuretic, an ACE inhibitor, or an ARB. A mean decrease in blood pressure of 21±20 mm Hg/10±14 mm Hg and 25±20 mm Hg/12±12 mm Hg was observed at 6 weeks and 6 months of therapy, respectively. THE GENERAL BENEFIT OF ALDOSTERONE RECEPTOR ANTAGONISTS (ARAS) IN PATIENTS WITH RESISTANT HYPERTENSION SUGGESTS THAT ALDOSTERONE MAY BE A MORE COMMON DETERMINANT OF RESISTANT HYPERTENSION THAN WAS FIRST BELIEVED.

25 Nephrol Dial Transplant (2009) 1 of 11 doi: /ndt/gfp371 RENOPROTECTION INCREASED RENOPROTECTION WITH ACE INHIBITOR PLUS ALDOSTERONE ANTAGONIST AS COMPARED TO MONOTHERAPIES—THE EFFECT ON PODOCYTES Zalan Nemeth, Gabor Kokeny, Maria Godo, Miklos Mozes, Laszlo Rosivall,Marie-Luise Gross, Eberhard Ritz and Peter Hamar

26 Nephrol Dial Transplant (2009) 1 of 6 doi: /ndt/gfp511 THE IMPACT OF STOPPING INHIBITORS OF THE RENIN– ANGIOTENSIN SYSTEM IN PATIENTS WITH ADVANCED CHRONIC KIDNEY DISEASE Aimun K. Ahmed, Neetha S. Kamath, Mohsen El Kossi and A. Meguid El Nahas Sheffield Kidney Institute, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

27 NDT Plus (2011) 4: 99–100 doi: /ndtplus/sfq218 Advance Access publication 21 February 2011 Case Report Idiopathic or iatrogenic membranous glomerulonephritis? A case of spironolactone-induced membranous glomerulonephritis Akimichi Inaba, Milind Nikam, Colin Short and Michael Venning Department of Renal Medicine, Manchester Royal Infirmary, Manchester, UK

28 Spironolacton által okozott nephrosis szindróma

29 DNN 2008A MAGAS SZÉRUM KÁLIUM EREDETE ÉS KÖVETKEZMÉNYEI 29 ©2008 UpToDate ® this to a colleagu this to a colleague NAPI 30 TBL KÁLIUM-R EGÉSZSÉGESEKNEK ©2008 UpToDate ® Licensed to UpToDate Guest Pass SupportTag: [ecapp0503p.utd.com A9C99DEF- 2579]


Download ppt "Spironolactone: An Old Friend Rediscovered Domenic A. Sica MD The Journal of Clinical Hypertension Volume 8, Issue 7, Volume 8, Issue 7, pages 467–469,"

Similar presentations


Ads by Google