Explore chapters and articles related to this topic
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
Medications in this class of drugs may be used short-term for inpatients with HF who show signs of volume overload along with severe hypervolemic hyponatremia unresponsive to optimized medical therapy, or who are at risk of having active cognitive symptoms secondary to hyponatremia.44 In the setting of AHF, hyponatremia indicates water accumulation/retention, which is associated with a poorer prognosis.60 Chapter 5 addresses details of V1 and V2 receptor selectivity and other important pharmacologic characteristics of vasopressin receptor antagonists (VRAs). Tolvaptan and conivaptan are the two VRAs most used to induce aquaresis in these patients. The Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study with Tolvaptan (EVEREST) study sought to evaluate patients hospitalized with HF and compare outcomes in those given tolvaptan or a placebo. The study ultimately showed no difference in long-term clinical outcomes between the two groups, although it did show a benefit in the tolvaptan group with regard to symptomatology and volume overload.61 Other smaller studies have failed to reproduce these results.62 Both tolvaptan and conivaptan are contraindicated for use in combination with strong CYP450 3A4 inhibitors.
Hyponatremia in pregnancy
Published in Nadia Barghouthi, Jessica Perini, Endocrine Diseases in Pregnancy and the Postpartum Period, 2021
Anthony Parravani, Bethany Pellegrino
Nonpregnant state, maintenance of serum osmolality and sodium:Under nonpregnant conditions, serum osmolality is maintained within a narrow range of 275–295 mOsm/L.Any changes in serum osmolality are sensed by osmoreceptors which respond to correct the change.An increase in serum osmolality by 1–2% results in the release of ADH from the posterior pituitary, which acts on the Arginine Vasopressin Receptor 2 (AVPR2) on the basolateral membrane of the collecting ducts in the kidneys. This leads to the upregulation of aquaporin 2 channels and increased water absorption by the kidneys.Any increase in serum osmolality also stimulates the thirst center in the hypothalamus, resulting in water intake to assist in correction of the hypertonic state.4
Renal
Published in Faye Hill, Sash Noor, Neel Sharma, Tiago Villanueva, Medical and Surgical Emergencies for Students and Junior Doctors, 2021
Faye Hill, Sash Noor, Neel Sharma
From a pharmacological perspective, individuals with SIADH (syndrome of inappropriate antidiuretic hormone secretion – elevated urine osmolality and low plasma osmolality) are best managed with demeclocycline. In addition, vaptans and arginine vasopressin receptor antagonists have been utilised in the management of euvolaemic and hypervolaemic hyponatraemia.
The pharmacotherapeutic options in patients with catecholamine-resistant vasodilatory shock
Published in Expert Review of Clinical Pharmacology, 2022
Timothy E. Albertson, James A. Chenoweth, Justin C. Lewis, Janelle V. Pugashetti, Christian E. Sandrock, Brian M. Morrissey
The endogenous hormone vasopressin circulates in the blood after it is released from the posterior pituitary gland. VP mainly ensures osmoregulation by its effect on the arginine vasopressin receptor 2 (AVPR2) located primarily in the distal convoluted tubules promoting water retention. The antidiuretic hormone effect is normally the major effect of VP, but in shock conditions, even higher circulatory levels of VP are naturally released. These higher levels also stimulate arginine vasopressin receptor 1a (AVPR1a) generating powerful vasoconstriction. Potentially when VP is given exogenously, it maintains better kidney perfusion than exogenous NE because there are more AVPR1a receptors in the glomerular efferent than afferent arterioles [21]. In addition, the stimulation of arginine vasopressin receptor 1b (AVPR1b) by VP generates the release of adrenocorticotropic hormone (ACTH) from the anterior pituitary resulting in release of cortisol from the adrenal gland. The higher levels of ACTH generated by VP release generate increased natural levels of endogenous cortical steroids in shock patients.
Can treatment response to SGLT2-inhibitors in syndrome of inappropriate antidiuresis be predicted by copeptin, natriuretic peptides and inflammatory markers?
Published in Biomarkers, 2021
Rianne Nobbenhuis, Julie Refardt, Deborah Vogt, Clara O. Sailer, Bettina Winzeler, Mirjam Christ-Crain
The most common but often unsuccessful treatment of SIAD is fluid restriction (Verbalis et al.2016). Vasopressin receptor antagonists (vaptans) can be used for the treatment of SIAD but are costly and bear the risk of plasma sodium overcorrection (Verbalis et al.2016). Urea as another treatment option is poorly tolerated resulting in a low compliance (Lockett et al.2019). We have recently shown that empagliflozin, a sodium glucose cotransporter-2 (SGLT2) inhibitor, through induction of osmotic diuresis, leads to higher plasma sodium levels than placebo in hospitalized patients with SIAD (Refardt et al.2020). However, not all patients responded to this treatment. To optimize initial treatment success and minimize adverse effects due to ineffective treatment options, a biomarker predicting treatment response would be highly desirable.
Pharmacological management of portal hypertension and its complications in children: lessons from adults and opportunities for the future
Published in Expert Opinion on Pharmacotherapy, 2021
Sarah Henkel, Carol Vetterly, Robert Squires, Patrick McKiernan, James Squires
The vasopressin receptor (V2) antagonist tolvaptan, which increases the excretion of free water, has been shown to increase serum sodium at 4 and 30 day intervals in two double blind, placebo controlled phase 3 studies (SALT-1 and SALT-2) of patients with multiple different underlying diseases, including cirrhosis [55]. In cirrhotic patients with hyponatremia, tolvaptan has been shown to improve 6-month survival outcomes if normonatremia was achieved, and to improve ascites in patients with cirrhosis and normal serum sodium and renal function [56,57]. In pediatric patients, tolvaptan has been used in ADPKD and in SIADH without hepatic compromise, but data are otherwise limited in children [57]. In 2013, the U.S. Food and Drug Administration issued a safety alert for tolvaptan due to possible liver injury. The drug labeling was updated to include limiting treatment duration to 30 days, remove the indication for use in patients with cirrhosis, and discontinue use in patients with hepatic injury.