Overview Snapshot A 63-year-old man with a history of congestive heart failure presents with increased pedal edema and worsening orthopnea. He reports that he has been taking his lisinopril as prescribed and adhering to a low-salt diet. Physical exam shows 2+ pitting edema in the knees bilaterally and faint crackles on auscultation of the lungs. Left ventricular ejection fraction (LVEF) is measured by echocardiogram and found to be 33%. This is decreased from his last measurement of 38%. He is put on an additional medication. (Congestive heart failure exacerbations) Spironolactone and Eplerenone Mechanism competitive aldosterone receptor antagonist in the cortical collecting tubule reduces potassium secretion by decreasing activity of the epithelial sodium channel (ENAC) and the apical potassium channel Clinical use hyperaldosteronism potassium wasting from loop or thiazide diuretics congestive heart failure (CHF) decreases ventricular remodeling reduces mortality antiandrogenic treatment for female hirsutism Toxicity hyperkalemia can result in arrhythmias spironolactone has antiandrogen effects causes gynecomastia eplerenone causes gynecomastia to a lesser extent Triamterene and Amiloride Mechanism blocks ENAC in the cortical collecting duct, thereby leading to decreased sodium reabsorption indirectly reduces potassium secretion by creating a more positive luminal potential indirectly decreases activity of the apical proton ATPase and reduces secretion of protons does not cause anti-androgen effects Clinical use congestive heart failure (CHF) potassium wasting lithium-induced nephrogenic diabetes insipidus amiloride Toxicity hyperkalemia normal anion gap metabolic acidosis
QUESTIONS 1 of 7 1 2 3 4 5 6 7 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.RL.14.13) A 70-year-old Caucasian male visits your office regularly for treatment of New York Heart association class IV congestive heart failure. Which of the following medications would you add to this man's drug regimen in order to improve his overall survival? QID: 100967 Type & Select Correct Answer 1 Spironolactone 60% (88/147) 2 Amiloride 7% (11/147) 3 Hydrochlorothiazide 8% (12/147) 4 Furosemide 20% (30/147) 5 Acetazolamide 1% (1/147) M 4 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (M1.RL.13.50) A 58-year-old man who had been complaining of increased shortness of breath with exertion and paroxysmal nocturnal dyspnea was started on a medical regimen to help stabilize his condition and relieve his fluid retention. Though his symptoms were improving, he noticed bilateral breast enlargement (Figure A) and returned to the clinic. The drug responsible for his breast enlargement also functions to do which of the following? QID: 101004 FIGURES: A Type & Select Correct Answer 1 Increase the PR interval on EKG 4% (9/209) 2 Inhibit angiotensin converting enzyme 2% (5/209) 3 Bind mineralcorticoid receptors 78% (163/209) 4 Inhibit the Na+/K+/2Cl- triple transporter in the thick ascending limb of the loop of Henle 11% (24/209) 5 Increase tubular fluid osmolarity 3% (7/209) M 1 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic