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Cardiovascular Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Potassium-sparing diuretics include amiloride, spironolactone, and triamterene, and result in sodium and water loss while sparing potassium. Spironolactone is a competitive inhibitor of aldosterone, while amiloride and triamterene function at the level of the collecting tubules.
Body fluids and electrolytes
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Potassium-sparing diuretics, as the name suggests, work to preserve potassium. They inhibit sodium reabsorption in the concluding parts of the distal tubule and the early collecting duct. They may be used alongside another type of diuretic to preserve potassium in the body. It is important to note that these diuretics carry a risk of hyperkalaemia, especially for those with chronic kidney disease or individuals taking drugs that also increase potassium concentration, i.e., ACE inhibitors or beta-blockers (Casey 2019).
Heart disease in the elderly
Published in Clive Handler, Gerry Coghlan, Nick Brown, Management of Cardiac Problems in Primary Care, 2018
Clive Handler, Gerry Coghlan, Nick Brown
Potassium supplements should be stopped if potassium-sparing diuretics are prescribed. The combination of a loop diuretic and an aldosterone antagonist is less likely to be effective if the glomerular filtration rate is less than 40 ml/minute.
Machine learning algorithms identify hypokalaemia risk in people with hypertension in the United States National Health and Nutrition Examination Survey 1999–2018
Published in Annals of Medicine, 2023
Ziying Lin, Yuen Ting Cheng, Bernard Man Yung Cheung
The administration of renin-angiotensin system blockers (ACEIs/ARBs) is suggested by guidelines as the first approach to managing hypertension [21,32,33]. The combination of ACEIs/ARBs or potassium-sparing diuretics is a common strategy for hypertensive patients with a baseline use of diuretics, especially those with a high hypokalaemia risk or comorbid heart failure [34]. Our study showed that using potassium-sparing diuretics was associated with hypokalaemia. Although no causal relationship between potassium-sparing diuretics use and hypokalaemia could be ascertained in this study, the increased hypokalaemia risk in patients on potassium-sparing diuretics highlights the importance of a more comprehensive evaluation of the cause of hypokalaemia, including hyperaldosteronism and potential resistant hypertension [35,36]. Also, stricter blood pressure monitoring and re-evaluation of diuretics dosage are needed.
Diuretic therapy in congestive heart failure
Published in Acta Cardiologica, 2022
Patrick Kennelly, Rajju Sapkota, Maimoona Azhar, Faisal Habib Cheema, Claire Conway, Aamir Hameed
A complication of potassium-sparing diuretics that must be monitored is hyperkalaemia. The prevalence of elevated serum potassium is approximately 9% in patients using spironolactone [34]. Concurrent use of potassium sparing drugs with ACE inhibitors must be monitored due to an increased risk of hyperkalaemia. A 2003 study investigating combined use of spironolactone with ACE inhibitors or angiotensin receptor blockers in heart failure patients identified a significant risk of life-threatening hyperkalaemia. Predisposing factors identified for the occurrence of severe hyperkalaemia include age (mean age of 76), increased dose of spironolactone (mean dose 88 mg/day), diabetes type 2 and reduced renal function [46]. Monitoring of potassium, dosing, and renal function with the use of potassium sparing diuretics is also essential due to the increased risk of hyperkalemia [3].
The effect of hospitalization on potentially inappropriate medication use in older adults with chronic kidney disease
Published in Current Medical Research and Opinion, 2019
Wubshet H. Tesfaye, Barbara C. Wimmer, Gregory M. Peterson, Ronald L. Castelino, Matthew D. Jose, Charlotte McKercher, Syed Tabish R. Zaidi
The use of MAI resulted in the identification of more PIMs than using Beers criteria. This is because the MAI, as an implicit measure, addresses broad aspects of pharmacotherapy. For example, dosage appropriateness is one element of MAI that explicit measures do not address. Drug–drug interactions were another important prescribing quality indicator assessed using the MAI. Major drug interactions were identified in 20% and 18% of patients at admission and discharge, respectively. An example was the concomitant use of amiodarone and warfarin, an interaction that increases the risk of bleeding33. Other clinically relevant interactions from this study included the use of angiotensin-converting enzyme inhibitors with potassium-sparing diuretics and the use of multiple central nervous system acting medications. Although the MAI identified more PIMs than Beers criteria, the time it takes for evaluation makes it less feasible for actual clinical use. Nevertheless, our study demonstrated a strong association between Beers criteria and MAI. Therefore, in clinical practice, the former can serve as a surrogate measure for evaluation of PIM use in these patients10. The updated Beers criteria have dosage recommendations for some renally cleared medications and major drug interactions, which boosts its potential as a standalone PIMs measure in older CKD patients.