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Therapeutic Approaches in Acute Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Getu Teressa, Rachel A. Bright, Andreas P. Kalogeropoulos
There are no large-scale clinical trials that have examined the use of diuretics for AHF, but loop diuretics are generally considered the preferred first-line therapy, whereas other classes of diuretics are used as adjuncts. Commonly used loop diuretics include furosemide, torsemide, bumetanide, and ethacrynic acid. Ethacrynic acid is a non-sulfonamide-based loop diuretic commonly used in patients with hypersensitivity to sulfonamide. Adjunct non-loop diuretics commonly used are thiazide or thiazide-like diuretics, and sometimes natriuretic doses of mineralocorticoid receptor antagonists (MRAs). A basic understanding of diuretic pharmacology is covered in Chapter 5. Additional major points relevant to AHF are discussed in the current chapter.
Sodium Intake and Hypertension
Published in Austin E. Doyle, Frederick A. O. Mendelsohn, Trefor O. Morgan, Pharmacological and Therapeutic Aspects of Hypertension, 2020
T. O. Morgan, F. A. O. Mendelsohn, A. E. Doyle
Ethacrynic acid has a specific additional action on hydrogen ion excretion, and this effect may be useful in renal failure. Ethacrynic acid can be used in high doses, but if used in renal failure may be associated with deafness. In these circumstances, furosemide is the drug of choice.
Pharmacology and Toxicology of Loop Diuretics in Pediatrics
Published in Sam Kacew, Drug Toxicity and Metabolism in Pediatrics, 1990
Although the therapeutic benefit derived from ethacrynic acid use in infants with acute glomerulonephritis was questioned,119 Sparrow et al.120 reported a significant diuresis and clinical improvement in all children with congestive heart failure after administration of this diuretic. The observed diuresis was rapid, did not change serum electrolyte concentration, and failed to produce any apparent side effects. Similarly, Willard and Geisett121 found that ethacrynic acid was effective in the treatment of congestive heart failure in newborns. Thus, it is apparent that ethacrynic acid is of therapeutic benefit in the therapy of fluid overload associated with congestive heart failure in infants and is of questionable value in idiopathic edema in newborns.
An evaluation of torsemide in patients with heart failure and renal disease
Published in Expert Review of Cardiovascular Therapy, 2022
Anthony E. Peters, Robert J. Mentz, Tracy A. DeWald, Stephen J. Greene
Heart failure (HF) is a clinical syndrome marked by signs and symptoms of congestion that affects over ~6 million Americans and costs the health system over $30 billion per year [1–4]. Worldwide, heart failure prevalence is estimated at over 64 million [5]. HF accounts for a heavy burden of hospitalizations with over 800,000 hospital discharges in the U.S. each year [1]. These hospitalizations are generally driven by worsening congestion often related to volume overload, and associated with particularly high rates of post-discharge death and hospital readmission. Notably, non-cardiac comorbidities are playing an increasingly important role in the management of HF as well as clinical outcomes, particularly in heart failure with preserved ejection fraction (HFpEF) [6]. Renal disease, in particular, is a pervasive and impactful co-morbidity in HF and dramatically impacts the efficacy and safety of volume management [7,8]. In this context, maintenance of euvolemia in chronic HF and effective decongestion in decompensated HF are increasingly critical components of HF care. Loop diuretics remain the primary pharmacologic therapy to achieve these two objectives in HF management, as supported by recent guidelines [9]. Commonly utilized loop diuretics include furosemide, torsemide, and bumetanide, while ethacrynic acid serves an alternative for patients with hypersensitivity reactions to sulfonamide-containing loop diuretics. Notably, established guidelines do not specify differential recommendations or preference for particular loop diuretics [9].
Interactions of antiepileptic drugs with drugs approved for the treatment of indications other than epilepsy
Published in Expert Review of Clinical Pharmacology, 2020
Kinga K. Borowicz-Reutt, Stanisław J. Czuczwar, Marta Rusek
Thiazide (bendroflumethiazide, hydrochlorothiazide), thiazide-like (chlorthalidone, indapamide), and loop (furosemide, bumetanide) diuretics are the most commonly prescribed diuretic agents used to treat hypertension, particularly in patients with heart failure, or at risk of heart failure [147]. Łukawski et al. found that hydrochlorothiazide enhanced the anticonvulsant action carbamazepine but had no impact on the antielectroshock activity of the other AEDs [176]. In addition, hydrochlorothiazide and ethacrynic acid did not have an impact on the anticonvulsant activity of levetiracetam [177]. Indapamide was found to significantly potentiate the anticonvulsant activity of carbamazepine, phenobarbital, and valproate against MES in mice and the interactions with carbamazepine and valproate were apparently pharmacodynamic. As regards phenobarbital, its total brain concentration was raised by indapamide [178]. Most important drug interactions have been shown in Table 1.
Efflux pump inhibitors as a promising adjunct therapy against drug resistant tuberculosis: a new strategy to revisit mycobacterial targets and repurpose old drugs
Published in Expert Review of Anti-infective Therapy, 2020
Liliana Rodrigues, Pedro Cravo, Miguel Viveiros
This strategy also identified several antiarrhythmic, antihypertensive drugs that potentially target a probable metal cation transporter P-type ATPase A CtpF (Rv1997) in M. tuberculosis. Deslanoside is a cardiac glycoside used to treat congestive heart failure, supraventricular arrhythmias and to control ventricular rate in the treatment of chronic atrial fibrillation. This compound inhibits the Na+/K+-ATPase pump, resulting in an increase in intracellular sodium and calcium concentrations that may promote activation of contractile proteins, such as actin and myosin [162]. Acetyldigitoxin is a cardioactive derivative of lanatoside A or of digitoxin used for fast digitalization in congestive heart failure. The proposed mode of action is similar to deslanoside: inhibition of the Na+/K+ pump that leads to increased amounts of calcium [163]. Ethacrynic acid is used in the treatment of high blood pressure and edema caused by diseases like congestive heart failure, liver failure, and kidney failure. It inhibits the symport of sodium, potassium, and chloride primarily in the ascending limb of Henle. This pharmacological action results in excretion of these ions, increased urinary output, and reduction in extracellular fluid [164]. Finally, the last drug in this group is bretylium, used in emergency medicine, cardiology, and other specialties for the acute management of ventricular tachycardia and ventricular fibrillation. The main mode of action for bretylium is thought to be inhibition of voltage-gated potassium channels and the Na+/K+-ATPase [165].