NAPLEX Examination.
Naplex free Practice Questions;
Naplex
Aldosterone antagonists. Naplex Review
Spironolactone (Aldactone®) is a potassium-sparing diuretic but was the fi rst aldosterone antagonist available for clinical use in the United States, when it had been shown to have direct blocking eff ects on the actions of aldosterone. Results from a large study, the Randomized Aldactone Evaluation Study (RALES), revealed that the addition of low doses (12.5 to 25 mg daily) of spironolactone to patients with class IV symptoms (NYHA) taking ACEIs reduced the risk of death and hospitalization.
- Current national guidelines provide a class I recommendation with a level C level of evidence that spironolactone (Aldactone®) be considered in patients with stage C HF—as add-on therapy to ACEIs or ARBs and a -adrenergic blocker—who can be closely monitored for changes in renal function and potassium levels in those patients where previous therapy was not eff ective in resolving congestion.
- Patients receiving spironolactone should have serum potassium levels evaluated and reduced to 5.0 mEq/L along with a serum creatinine level 2.5 mg/dL before initiation of therapy. Potassium levels should be routinely monitored to prevent the subsequent development of hyperkalemia.
- Eplerenone (Inspra®) was the second aldosterone receptor antagonist introduced and is currently indicated in the treatment of hypertension and in post-MI patients with HF. It has not yet been formalized into the current national guidelines as spironolactone (Aldactone®) has been.
