HTN - Potassium Sparing Diuretics & K+ Supplements

Created by millersenn 

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Name the Potassium Sparing Diuretics.

Spironolactone
Eplerenone

What is the mechanism of action for potassium sparing diuretics?

Sythetic Aldosterone Antagonists - competes with aldosterone at renal receptor sites (Aldosterone normally stimulates Na+ reabsorption & K+ elimination at the distal tubule)
Causes Na+ elimination & K+ reabsorption

What are the therapeutic uses for Potassium sparing diuretics?

Improve morbidity & mortality in left ventricular systolic dysfunction (CHF with ejection fraction <40%); slows CHF disease profession.
Used in combination with thiazides or loops to help retain K+ & prevent hypokalemia.
Reduce portal vein HTN in liver failure pts with ascites.

How powerful are potassium sparing diuretics?

Not powerful enough as a diuretic to be used alone to treat edema.
Can be added when pt has resistant HTN (where pts are already on 3 or more drugs)

What is eplerenone generally reserved for & why?

Eplerenone is generally reserved for pts experiencing sex hormone-related side effects of spironolactone due to its increased cost ($115/mo as compared to $20/mo)

What are the adverse effects of potassium sparing diuretics?

Hyperkalemia (Can be life-threatening)
Spironolactone, since it chemically resembles some sex steroids, may cause gynecomastia (10%) in men & menstrual irregularities & deepening of voice in females. Eplerenone is more selective & does not cause these side effects.

What are the contraindications/precautions of using potassium sparing diuretics?

Serum K+ >5.5 mEq/L at initiation or CrCl <30 mL/min.
Use extreme caution if pts are receiving K+ supplements, ACE-I, ARBs, or using salt substitutes.
Eplerenone use is contraindicated with powerful CYP3A4 inhibitors such as macrolides, ketaconazole, itraconazole & others.

Name the K+ supplements.

amiloride
triamterene

What is the mechanism of action for amiloride & triamterene?

NOT aldosterone antagonists.
Act directly in the distal renal tubule to inhibit the Na+ reabsorption & K+ elimination that is normally stimulated by aldosterone.

What are the therapeutic uses for amiloride & triamterene?

Mostly used to help retain K+ & prevent hypokalemia; NOT used in management of CHF or portal vein HTN like spironolactone

What are the adverse effects of amiloride & triamterene?

RIsk of hyperkalemia is just as much of a concern; do NOT cause hormone-related ADRs

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