55 Aldosterone Inhibitors Diuretic S

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55 Aldosterone Inhibitors Diuretic S

  1. 1. ÁíôáãùíéóôÝò ôçò áëäïóôåñüíçò Canrenone / spironolactone / eplerenone ÐåñéëáìâÜíåôáé ç óðåéñïíïëáêôüíç ðïõ Ý÷åé áóèåíÞ äéïõñçôéêÞ äñÜóç. Äñá áíôáãùíéóôéêþò ðñïò ôçí áëäïóôåñüíç êáé ðñïêáëåß êáôáêñÜôçóç êáëßïõ. Åíéó÷ýåé ôç äñÜóç ôùí èåéáæéäéêþí êáé ôùí äéïõñçôéêþí ôçò áãêýëçò. ÐñïôéìÜôáé óå 1. ïéäÞìáôá Þ áóêßôç êéññùôéêþí áóèåíþí êáé åíßïôå 2. óå ïéäÞìáôá êáñäéáêÞò áíåðÜñêåéáò, ðïõ åßíáé áíèåêôéêÜ óå Üëëá äéïõñçôéêÜ. ¸÷åé áíáöåñèåß êáñêéíïãÝíåóç Þðáôïò êáé åíäïêñéíþí áäÝíùí óå ðåéñáìáôüæùá. Ç åðëåñåíüíç åìðïäßæåé ôç óýíäåóç ôçò áëäïóôåñüíçò óôï óýóôçìá ñåíßíçò-áããåéïôáóßíçò, ôï ïðïßï åìðëÝêåôáé óôçí ðáèïöõóéïëïãßá ôçò êáñäéáããåéáêÞò íüóïõ.
  2. 2. ÅÐËÅÑÅÍÏÍÇ ÁëëçëåðéäñÜóåéò: Eplerenone 1. Ìå Üëëá ðñïóôáôåõôéêÜ ôçò áðþëåéáò êáëßïõ Åíäåßîåéò: áõîÜíåé ï êßíÍäõíïò õðåñêáëéáéìßáò, ÅðéêïõñéêÞ èåñáðåßá åðß áóèåíþí 2. êáèþò êáé ìå áÌÅÁ êáé ìå óôáèåñïðïéçìÝíç äõóëåéôïõñãßá 3. áíôáãùíéóôÝò ôùí õðïäï÷Ýùí ôçò áããåéïôáóßíçò. ôçò áñéóôåñÞò êïéëßáò êáé êáñäéáêÞ áíåðÜñêåéá, 4. Ç êõêëïóðïñßíç, ôï ôáêñüëéìïõò êáé ôá ÌÓÁÖ ìåôÜ áðü Ýìöñáãìá ôïõ ìõïêáñäßïõ áõîÜíïõí ôïí êßíäõíï íåöñïôïîéêüôçôáò, (Ýíáñîç 3-4 çìÝñåò ìåôÜ ôï 5. ïé á1-áðïêëåéóôÝò êáé ôá ôñéêõêëéêÜ óõìâÜí). áíôéêáôáèëéðôéêÜ áõîÜíïõí ôïí êßíäõíï õðüôáóçò, åíþ Áíôåíäåßîåéò: 6. ôá êïñôéêïåéäÞ ìåéþíïõí ôçí áíôéõðåñôáóéêÞ äñÜóç. 1. Õðåñêáëéáéìßá, 2. áóèåíåßò ðïõ ëáìâÜíïõí Üëëá ðñïóôáôåõôéêÜ ôçò Ðñïóï÷Þ óôç ÷ïñÞãçóç: áðþëåéáò êáëßïõ öÜñìáêá Ðáñáêïëïýèçóç ôçò óôÜèìçò ôïõ êáëßïõ (íá ìçí 3. Þ éó÷õñïýò áíáóôïëåßò ôïõ åíæýìïõ CYP3A4 áñ÷ßæåé èåñáðåßá áí ôï êÜëéï åßíáé >5.0 mmol/L). (éôñáêïíáæüëç ê.ë.ð.), 4. ìÝôñéá Ýùò óïâáñÞ íåöñéêÞ 5. Þ óïâáñÞ çðáôéêÞ áíåðÜñêåéá. Óå íåöñéêÞ êáé çðáôéêÞ áíåðÜñêåéá. Ðáñáêïëïýèçóç ôçò óôÜèìçò Áíåðéèýìçôåò åíÝñãåéåò: ôïõ ëéèßïõ áí áðáéôåßôáé ç ÷ïñÞãçóÞ ôïõ. 1. Õðåñêáëéáéìßá, 2. õðüôáóç, Óå áóèåíåßò ìå äõóáíåîßá óôç ãáëáêôüæç 3. íáõôßá, äéÜññïéá, Ýìåôïé Þ óå äõóáðïññüöçóç ãëõêüæçò-ãáëáêôüæçò. 4. ßëéããïé, êåöáëáëãßá 5. Ýêðôùóç íåöñéêÞò ëåéôïõñãßáò, óðáíéüôåñá Äïóïëïãßá: 6. áûðíßá, ¸íáñîç ìå 25mg çìåñçóßùò 7. åîáóèÝíçóç, 8. áöõäÜôùóç, êáé áýîçóç, åÜí áðáéôåßôáé, óå 50 mg çìåñçóßùò 9. áñôçñéáêÝò èñïìâþóåéò, ìåôÜ áðü 4 åâäïìÜäåò. Äåí 10. êïëðéêÞ ìáñìáñõãÞ, ÷ïñçãåßôáé óå ðáéäéÜ 11. çùóéíïöéëßá, ÖáñìáêåõôéêÜ ðñïúüíôá: 12. äõóëéðéäáéìßá, INSPRA/Pfizer: f.c.tab 25mg x 20, 50mg x 20 13. õðïíáôñéáéìßá
  3. 3. ÓÐÅÉÑÏÍÏËÁÊÔÏÍÇ Áíåðéèýìçôåò åíÝñãåéåò: Spironolactone Åíäåßîåéò: Õðåñêáëéáéìßá êáé ãõíáéêïìáóôßá ïé óðïõäáéüôåñåò. 1. Oßäçìá êáé áóêßôçò óå Ýäáöïò êßññùóçò ôïõ Þðáôïò, êáêïÞèçò áóêßôçò, Åðßóçò 2. íåöñùóéêü óýíäñïìï, 1. õðåñ÷ëùñáéìéêÞ ïîÝùóç (éäéáéôÝñùò óå 3. óõìöïñçôéêÞ êáñäéáêÞ áíåðÜñêåéá óå ìç êéññùôéêïýò), 2. áýîçóç ïõñßáò êáé ïõñéêïý ïîÝïò áßìáôïò, áíôáðüêñéóç óå Üëëá öÜñìáêá Þ üôáí ç ÷ïñÞãçóç 3. ìáóôùäõíßá, äáêôõëßôéäáò åßíáé áíáðüöåõêôç, 4. äéáôáñá÷Ýò åììÞíïõ ñýóçò, 5. ìåßùóç ôçò libido êáé áíéêáíüôçôá óôïõò 4. ðñùôïðáèÞò õðåñáëäïóôåñïíéóìüò. Üíäñåò. 5. ÉäéïðáèÞò õðÝñôáóç óå óõíäõáóìü ìå Üëëá 6. Åíßïôå ãáóôñåíôåñéêÝò äéáôáñá÷Ýò êáé öÜñìáêá, üôáí Üëëá èåñáðåõôéêÜ ó÷Þìáôá äåí óðáíßùò Ýëêïò, 7. åîáíèÞìáôá, Ý÷ïõí áðïäüóåé. 8. êåöáëáëãßá, õðíçëßá,óýã÷õóç, 6. Õðïêáëéáéìßá, üôáí Üëëá èåñáðåõôéêÜ ìÝóá 9. áôáîßá, ðõñåôüò. êñßíïíôáé áêáôÜëëçëá Þ áíåðáñêÞ. ÁëëçëåðéäñÜóåéò: Ìå êáëéïý÷á óêåõÜóìáôá êáé áíáóôïëåßò ôïõ ìåôáôñåðôéêïý åíæýìïõ, áõîçìÝíïò êßíäõíïò Áíôåíäåßîåéò: õðåñêáëéáéìßáò. ÁõîÜíåé ôá åðßðåäá ôïõ ëéèßïõ óôï áßìá, åíéó÷ýåé 1. Õðåñêáëéáéìßá, ôç äñÜóç Üëëùí äéïõñçôéêþí êáé 2. óïâáñÞ íåöñéêÞ áíåðÜñêåéá, áíïõñßá, ôùí áíôéõðåñôáóéêþí öáñìÜêùí, 3. íüóïò ôïõ Addison, 4. õðåñêáëéáéìßá. ìåéþíåé ôçí áíôáðüêñéóç ôùí áããåßùí óôç íïñáäñåíáëßíç êáé ôç äñÜóç ôùí áðü ôïõò óôüìáôïò áíôéðçêôéêþí.
  4. 4. Ðñïóï÷Þ óôç ÷ïñÞãçóç: ÖáñìáêåõôéêÜ ðñïúüíôá: ALDACTON Óýã÷ñïíç ÷ïñÞãçóç E/Pfizer: f.c.tab 25mg x 20, 100 êáëßïõ Þ ôñïöþí ðëïýóéùí óå êÜëéï mg x 20 ìðïñåß íá ðñïêáëÝóåé åðéêßíäõíç õðåñêáëéáéìßá. Ðåñéïäéêüò Ýëåã÷ïò ôïõ êáëßïõ ôïõ ïñïý, éäéáßôåñá óå íåöñïðáèåßò. Åðßóçò óå äéáâÞôç êáé çëéêéùìÝíá Üôïìá. Äïóïëïãßá: Óôçí éäéïðáèÞ õðÝñôáóç óõíÞèçò äüóç 50-100mg çìåñçóßùò, ç ïðïßá ìðïñåß íá áõîçèåß Ýùò 200 mg çìåñçóßùò. Óå ïéäÞìáôá äéáöüñïõ áéôéïëïãßáò 100mg çìåñçóßùò ìå âáèìéáßá áýîçóç óå åðßìïíåò ðåñéðôþóåéò Ýùò 200mg çìåñçóßùò. Óôïí ðñùôïðáèÞ õðåñáëäïóôåñïíéóìü 100-400mg çìåñçóßùò ùò ðñïåôïéìáóßá ãéá ôç ÷åéñïõñãéêÞ åðÝìâáóç Þ áíáæÞôçóç ôçò ìéêñüôåñçò èåñáðåõôéêÞò äüóçò óå áíôÝíäåéîÞ ôçò. Óå õðïêáëéáéìßá áðü ëÞøç äéïõñçôéêþí 25-100mg çìåñçóßùò.
  5. 5. Search: Go Advanced Search Circulation Home Subscriptions Archives Feedback Authors Help AHA Journals Home Circulation. 2009;120:S886-S887 « Previous Article | Table of Contents | Next Article » (Circulation. 2009;120:S886-S887.) This Article © 2009 American Heart Association, Inc. Alert me when this article is cited Alert me if a correction is posted Novel Approaches to Pharmacologic Intervention in Heart Services Failure Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Abstract 3916: Effect of Eplerenone Versus Request Permissions Spironolactone on Adiponectin and Hemoglobin Google Scholar A1c Levels in Patients With Chronic Heart Articles by Tsutamoto, T. Articles by Horie, M. Failure PubMed Articles by Tsutamoto, T. Takayoshi Tsutamoto; Keizo Nishiyama; Masayuki Yamaji; Articles by Horie, M. Chiho Kawahara; Masanori Fujii; Masaru Hayashi; Minorue Horie Shiga Univ of Med Science, Otsu, Japan Background. Adiponectin has important metabolic effects including insulin sensitivity and plasma adiponectin level is elevated in patients with chronic heart failure (CHF). Hemoglobin A1c (HbA1c) level is reported to be an independent risk factor for mortality in CHRAM study population, suggesting the important role of insulin resistance in CHF. Methods and Results. To compare the metabolic effect of a selective mineralocorticoid receptor blocker eplerenone with spironolactone in patients with CHF, 84 stable outpatients of CHF who received standard therapy such as ACE-I or ARB and b blockers, were randomized (1:2) to spironolactone (25mg/day) or eplerenone (50mg/day). We measured plasma levels of brain natriuretic peptide (BNP), adiponectin, HbA1c and cortisol were determined before and 4 months after either spironolactone or eplerenone. There was no difference in the baseline characteristics including hemodynamics and plasma levels of biomarkers between two groups. In both groups, plasma BNP levels were significantly decreased and plasma aldosterone levels were significantly increased after 4 months. In patients receiving spironolactone (n=29), plasma adiponectin was significantly decreased (14.5±9.1 vs. 11.8±8.4 ug/mL, p=0.0004) and HbA1c was significantly increased (5.6±0.6 vs. 5.9±0.7 %, p<0.001), and cortisol was significantly increased (11.6±4.8 vs. 14.3±4.5 ug/dL, p<0.05). In patients receiving spironolactone, there was a significant correlation between the changes of cortisol and the changes of HbA1c (r=0.454, p=0.013) and there was no correlation between the changes of adiponectin and the changes of HbA1c. In contrast, in patents receiving eplerenone (n=55) plasma adiponectin did not change (14.5±9.5 vs. 13.9±9.8 ug/mL, p=0.201) and HbA1c did not change (5.6±0.6 vs. 5.6±0.7 %, p=0.854), and cortisol did not change (12.3±4.6 vs. 13.2±4.5 ug/dL, p=0.131).
  6. 6. Conclusion. These findings indicate that the metabolic effects of eplerenone are different from those of spironolactone and that a selective mineralocorticoid receptor blocker eplerenone is superior to spironolactone in metabolic effects in patients with CHF. This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Tsutamoto, T. Articles by Horie, M. PubMed Articles by Tsutamoto, T. Articles by Horie, M.
  7. 7. Home About Privacy Register Free FAQ Contact Terms of Use Preview Sign-in for full Details Username Password Sign-in free and Explore the Exciting World of BiomedExperts: Over 1,800,000 Profiles Manage your own Profile More than 3,500 Organizations worldwide Locate Experts in your Country/Region State of the Art Network Visualizations Locate Experts in your 1. and 2. Level Network Forgot Password? Connect to Experts Worldwide Health Economics Disease burden, cost effectiveness modelling, HTA dossier services. www.creativ-ceutical.com find experts for 2008: Karagiannis Asterios; Tziomalos Konstantinos; Papageorgiou Athanasios; Kakafika Anna I; Sign in free and see... Pagourelias Efstathios D; Anagnostis Panagiotis; Athyros Vasilios G; Mikhailidis Dimitri P Aldosterone Antagonists Spironolactone versus eplerenone for the treatment of idiopathic hyperaldosteronism. Antihypertensive Agents Expert opinion on pharmacotherapy 2008;9(4):509-15. Visualized networks: Blood Pressure See your personal network in Drug Administration Schedule sophisticated graphical views Drug Dose-Response Relationship The aim of this prospective, randomised, open-label, blinded-end point study was to compare Gynecomastia the efficacy and safety of eplerenone versus spironolactone in patients with bilateral idiopathic Hyperaldosteronism hyperaldosteronism (IHA). After a 2-week washout period, 34 patients with IHA were assigned Hyperkalemia to receive either spironolactone 25 mg b.i.d. (n = 17) or eplerenone 25 mg b.i.d. (n = 17) for Hypertension 24 weeks. If the patients' blood pressure (BP) was not < 140/90 mmHg, the doses were Hypokalemia gradually increased up to 400 mg for spironolactone and 200 mg for eplerenone. If the patients' Potassium BP remained uncontrolled, a daily dose of hydrochlorothiazide 12.5 mg was added at week 16. Prospective Studies The primary outcome was the percentage of patients with BP < 140/90 mmHg at 16 weeks Spironolactone (i.e., with aldosterone antagonist monotherapy). The patients' BP was normalised in 13 out of Time Factors 17 (76.5%) and 14 out of 17 (82.4%) patients in the spironolactone and eplerenone groups, Treatment Outcome respectively (p = 1.00). Systolic BP decreased more rapidly with eplerenone. Serum potassium GeoTargeted Searches: levels were normalised (> 3.5 mmol/l) in all patients at 4 weeks. Mild hyperkalaemia was Locate experts around the world observed in two patients receiving 400 mg of spironolactone and in three patients receiving 150 and connect with global collaborators Sign-in to see more mg of eplerenone. Two patients presented with bilateral painful gynaecomastia at the end of week 16 while receiving 400 mg of spironolactone. Switching spironolactone to 150 mg of eplerenone daily resulted in resolution of gynaecomastia and also maintained BP control. At the end of the study, 19 patients were on eplerenone and 15 were on spironolactone. However, this did not affect the primary end point, because the switch from spironolactone to eplerenone (in two patients) occurred at the end of week 16. It was concluded that eplerenone was as effective as spironolactone in reducing BP in patients with IHA. The risk of mild hyperkalaemia was similar with both drugs. Post to CiteULike Research Profiles: See the visualized research activity of experts around the globe Sign-in to see more Home | FAQ | Contact | Privacy | Terms of Use
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