February 1, 2023

#PotassiumSparingDiUretic #Spironolactone #AldosteroneAntagonist Eplerenone

Hello people in this video we want to look at the potassium sparing diuretics so example is what spironolactone correct locked on so let us look at this one now first of all where we are we are looking at diuretics chapter diuretics means they dilute the urine urine will be very dilute they’ll be a lot of water loss from the body so if a person has edema you can

Give this so that he will lose the water excess water and also it can control hypertension it can reduce hypertension because it will reduce the blood volume water will become less right so blood volume will become listen the blood pressure will come down so that’s how you can treat hypertension also so we have seen the classification of diuretics we saw that there

Are high ceiling diuretics or loop diuretics example furuse amide taurus amide medium efficacy we saw thea sites and thea side like compounds like hydrochlorothiazide whence the azide floor thala down then we have come to a weak thea diuretics so in weak diuretics we have seen carbonic anhydrase inhibitors like acetazolamide which is used for a glaucoma treating

Glaucoma then we saw osmotic diuretic like mannitol glycerol isis or white etc now we are here potassium sparing diuretics currently we are here right so we are looking at potassium sparing diuretics so the things that can dilute the urine can remove excess water from our body right but they will not take potassium with them they will leave the potassium in our

Body and go so these are fed potassium sparing diuretics example spironolactone it is actually a pro drug which is converted into an active form in our body this is an aldosterone antagonist right it is an aldosterone antagonist are you able to see so it is an aldosterone antagonist spironolactone then you have renal epithelial sodium channel inhibitors example

Emil oh right okay so you should know at least these two names spironolactone and amine low right there’s actually one more a plea ren own app leerin own okay so basically let us look at the details now about spironolactone m f clear and known and emil oh right okay first of all understand the normal working of normal working of our body you should understand

Okay in this diagram we have tried to explain this then we will come to spironolactone first of all understand where we are okay this is a nephron correct this is the late in this distal collecting duct or it is the collecting duct okay we secured this collecting duct here what happens here this is the lumen right this yellow thing what is shown here this is the

Lumen this is the cell of the dcp and this is the blood blood vessel okay so here you have aldosterone which is in our body right that aldosterone which is a mineralocorticoid hormone it comes and binds to the mineralocorticoid receptor which is there in the cytoplasm of the cell okay then once it binds to this mineralocorticoid receptor the combination that is

Mineralocorticoid receptor that’s mr plus al net is aldosterone they enter the nucleus and then from here the synthesis of aip that is aldosterone induced protein aip happens now what is synthesized aldosterone induced protein is synthesized okay what will this aip do the job of this aip is to make sure that it is to make sure that sodium is reabsorbed into our

Body and potassium is thrown out in exchange okay this is the job normal physiology this is of aldosterone what aldosterone does okay this is what aldosterone does so what happens if sodium is taken in the sodium has taken to our body water also follow citrate sodium fall wherever sodium goes water goes so here in the urine there’ll be very little urine because

Water is being reabsorbed into the body but now you are giving spironolactone water spironolactone spironolactone is an and antagonist of aldosterone spironolactone is a antagonist of aldosterone so aldosterone work is opposite so what will happen here there is no aldosterone induced protein so sodium is not reabsorbed if sodium is not lea absorbed where will

Sodium go into the urine and potassium is not given away so potassium will be retained within us did you understand so now sodium is going into the urine so what will happen water will follow right as water follows there will no art of urine so now the body will lose water so there will be loss of water so edema and hypertension will get corrected so did you

Understand and basically here what happens potassium is not lost potassium levels in our body will be high you understood right so basically what one more thing you have to understand here guys so i hope you understood this much till now you know that you have seen so many diuretics till now now what they do like loop diuretics what they do they were increasing

The secretion of sodium so they loop diuretic was increasing the sodium levels in the urine then you had thea’s aids also which was increasing sodium level in the urine all the work of loop diuretic and thea side what was happening this aldosterone was the sodium potassium channel here was just reversing it this loop diuretic worked so hard and said let’s throw

Out the sodium thea’s i had said let’s work hard and throw the sodium out here there was one person sitting and said whatever you are throwing out now i am taking it i am taking the sodium and actually i’m going to throw potassium so this aldosterone was doing this kind of work where the effect of new diuretic and thea site was completely like it is like there

Is some problem here but sodium is being reabsorbed and potassium is being lost and we don’t want to lose potassium the more sodium they are throwing out the more potassium we are losing so to put an end to all this comes spironolactone spironolactone or other potassium sparing diuretics which are going to stop this so that whatever sodium has been thrown out has

To now go to the urine hence water will follow and there will be more urine so this is the effect of spironolactone or a plan run own or a meal oh right okay these are the potassium sparing diuretics so now let us look at the theory part spironolactone is an aldosterone antagonist this you already saw now you know this the structure is similar to aldosterone okay

It is a steroid yes it stops the reabsorption of sodium and it stops the loss of potassium this also you understood now as sodium is lost into the urine this acts as a diuretic because sodium is being thrown out of our body it acts as a diuretic as potassium is not lost it acts as a potassium sparing diuretic this is a pretty clear law hopefully sodium is law so

It’s a diuretic potassium is not lost so it is a potassium sparing diuretic calcium is also lost okay cashel is also removed it is secreted into the urine now coming to the pharmacokinetics of the spironolactone they are given orally the active motive metabolites of spironolactone as can drain on please focus here spine spironolactone is a prodrug the active

Metabolite is can drain own so this is what you should remember here spironolactone is a pro drug it is metabolized in liver doctor metabolite is can drain on okay another thing to note here is spironolactone works well when there is more aldosterone interesting it works well when there is more aldo steel so now let’s move on to the users of spironolactone it

Is used along with loop diuretics and thea’s ides to reduce potassium loss you already know this right so it is used along with loop diuretics and thiazide to reduce potassium loss edema it is used to treat any man this also you know what type of edema eye edema like nephrotic edema cirrhotic edema which is associated with hyperaldosteronism okay so edema okay

It is used along with luke diuretics and theia’s ides it is used to treat edema it is used to treat hypertension what type of hypertension resistant hypertension due to primary aldosterone listen it is also used to used in heart failure to reduce load on heart and it is also used in conn’s syndrome where there is primary hyperaldosteronism if there is primary

Hyperaldosteronism you can give an aldosterone antagonists like spironolactone okay so that completes the uses of this tablet spironolactone now let’s move on to the adverse drug reactions not at all difficult case what will it cost hyperkalemia because the blood cells potassium levels will increase and it will lead to nausea vomiting diarrhea peptic ulcer

Obviously you are giving it orally so all this can happen it’s a steroid it will have hormonal effects so in men it can lead to anti-angiogenic effect like gynecomastia can be their loss of libido can be their or decreased libido can be their in women that can be menstrual irregularities so the solution here is to give other potassium sparing diuretic like a

Play wren own which is light less likely to cause gynecomastia you know what gynecomastia and all is right in harsh winter the breast in male and there can be mental disturbances and other serious cns affects this so those were the adverse drug the reactions of spironolactone so if you know that it is a steroid if you know that it we’re retains potassium are

These difficult for you not at all right you know it’s given orally so all these problems will be there you know it’s a steroid so there will be hormonal problems you know it’s a potassium sparing diuretic so there will be hyperkalemia so all these are very simple adverse drug reactions now coming to drug interactions of spironolactone spironolactone basically

When you give it along with aca inhibitors or arb status angiotensin receptor blockers there can be dangerous hyperkalemia so the passion levels will increase to dangerous levels you should not give this along with potassium supplements right so if you were giving somebody potassium supplements and giving spironolactone he will go into hyperkalemia also bananas

Have lot of potassium so they should be very careful in their diet also aspirin blocks spironolactone action okay then look at this spironolactone degree increases the digoxin concentration so ngoc’s in toxicity who doesn’t increase almost all tablets on earth they mentioned the same thing right so that was the drug interaction of spironolactone i think that’s

All we wanted to cover so guys we are done with potassium sparing diuretics we have spoken off about spironolactone and eppley renn own right a milot ride also is a potassium sparing diuretic it’s a direct acting one and look at this it’s a renal epithelial sodium channel inhibitor obviously it will inhibit sodium channel wattles work they have on earth diuretics

They all want to inhibit sodium channels holy so guys we are winding up this video on potassium sparing diuretics we will meet you in the next video take care take risk bye bye

Transcribed from video
Pharmacology 652 a Potassium Sparing DiUretic Spironolactone Aldosterone antagonist Eplerenone By MBBS VPASS