Aldosterone antagonists

Question 1

Suffix
Aldosterone antagonists

Answer 1

one

Question 2

“one” drug class

Answer 2

aldosterone antagonist

Question 3

Generic names
Aldosterone antagonists

Answer 3

Eplerenone
Spironolactone

Question 4

Indication
Aldosterone antagonists

Answer 4

Aldosterone antagonists improve survival and decrease hospitalisations for heart failure with reduced ejection fraction when used with standard treatment.

Question 5

MOA
Aldosterone antagonists

Answer 5

Inhibit sodium absorption in the distal tubule by antagonising aldosterone, increasing sodium and water excretion and reducing potassium excretion; they are weak diuretics.

Aldosterone may contribute to the pathophysiology of heart failure; by reducing aldosterone activity, aldosterone antagonists improve outcome.

Question 6

Precautions
Aldosterone antagonists

Answer 6

Hyperkalaemia

treatment with NSAIDs can increase potassium levels

Question 7

Adverse effects
Aldosterone antagonists

Answer 7

Spironolactone and eplerenone may cause hyperkalaemia, especially in renal impairment or if used with ACE inhibitors, sartans, potassium-sparing diuretics or potassium supplements.

Question 8

Counselling and Practice points
Aldosterone antagonists

Answer 8

Do not take potassium supplements
Heart failure
check renal function and serum potassium concentration at baseline

Question 9

Drug class and indication

Eplerenone

Answer 9

Aldosterone antagonist
Reduction of risk of cardiovascular death in patients with heart failure and left ventricular impairment within 3–14 days of an acute MI (in combination with standard therapy)

Mild heart failure (NYHA class II) and left ventricular systolic dysfunction 30% or 35% with a QRS duration of 130 milliseconds

Question 10

Drug class and indication

Spironolactone

Answer 10

Aldosterone antagonist
* Chronic heart failure with reduced ejection fraction as part of standard treatment
* Primary hyperaldosteronism
* Refractory oedema associated with secondary hyperaldosteronism, eg cirrhosis of the liver
* Resistant hypertension (adjunct)
* Hirsutism in females

Question 11

Drug interactions
Aldosterone antagonists

Answer 11

NSAIDs + aldosterone antagonists
NSAIDs (including selective COX‑2 inhibitors) may increase the risk of hyperkalaemia (they can cause hyperkalaemia and also reduce renal function); monitor serum potassium and creatinine, particularly in the elderly and patients with renal impairment. Low-dose aspirin is unlikely to be a problem.