CV Aldosterone Agonists

Question 1

What are examples of aldosterone agonists?

Answer 1

1. Spironolactone

2. Epleronone

Question 2

What are the common indications for Aldosterone agonists?

Answer 2

1. Ascites and oedema due to liver cirrhosis: spironolactone used first line
2. Primary hypoaldosteronism

Question 3

What is the mode of action?

Answer 3

1. Aldosterone is a mineralocortcoid produced in adrenal cortex
2. Acts on the distal tubules of kidney.
3. Increase Na uptake and hence water
4. Elevates BP
5. Retains K
6. Spironolactone inhibits effects of Aldosterone
7. Hence increases water and Na excretion

Question 4

What are some important adverse effects?

Answer 4

1. Hyperkalaemia
2. Gynecomastia
3. Liver impairment
4. Stevens Johnson syndrome
5. T cell mediated hypersensitivity reaction

Question 5

Special warnings?

Answer 5

Contraindicated in patients with:

1. Severe renal disease
2. Hyperkalaemia
3. Addison’s
4. Pregnant/lactating women

Question 6

What are the important interactions to consider?

Answer 6

1. Combination with other potassium elevating drugs: ACE, ARB
2. Potassium supplements