Know your MCB!

January 16, 2012

Although the following article is not specific to PA I found it interesting and

informative. The summary is here but the " meat " is in the detail! Take the

test, write down your answers and no cheating! Then review the answers and

their detail.

Good luck and you'll win no matter how many answers you get wrong! And nobody

will know how smart you are unless you tell us!

The Resurrection of Spironolactone on Its Golden Anniversary

By Laurie G. Futterman, ARNP, MSN, CCRN and Louis Lemberg, MD

From the Division of Cardiology, Department of Medicine, University of Miami

School of Medicine, Miami, Fla.

Summary

The edematous states, specifically those in CHF and cirrhosis of the liver, are

associated with excessive aldosterone secretion and represent states of

secondary hyperaldosteremia. Aldosterone promotes sodium retention by the renal

tubules. Spironolactone, first introduced 50 years ago (1953), blocks the action

of aldosterone on renal transport of electrolytes, thus acting as an effective

diuretic, and in addition, has potentiating effects on other diuretics,

including the thiazides. Spironolactone has undesirable side effects that have

limited its clinical use; the most significant are impotence, gynecomastia, and

hirsutism. Eplerenone, a recently introduced selective ARA, decreases morbidity

and mortality in patients with CHF following MI and has none of the androgenic

or estrogenic side effects of spironolactone. Eplerenone is an effective

alternative for spironolactone.

- 65 yo super ob., fastidious male - 12mm X 13mm rt. a.adnoma with

previous rt. flank pain. Treating with DASH. Stats w/o meds = BP 175/90 HR 59

BS 125. D/C Spironolactone 12/20/2011 due to adverse SX.

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD

and PTSD.

Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and

Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS.

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