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Updated: Oct 12 2019

K-Sparing Diuretics

  • 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
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