Medications for Congestive Heart Failure and Adrenal Hyperplasia

Spironolactone and Eperenone

• Indicated for congestive heart failure, ascites, adrenal hyperplasia, or small cell carcinoma of the lung
• Also used for acne, hypertension, and amnorrhea

Mechanism of Action

• Both are aldosterone antagonists
• Spironolactone is also anti-androgenic

Side-Effects

• Spironolactone: hyperkalemia, gynecomastia due to anti-androgenic effects
• Eperenone: only hyperkalemia, no effects on testosterone receptor

Medications Known to Lower Mortality in CHF

• ACE Inhibitors
• Angiotensin Receptor Blockers
• Spironolactone and eperenone
• Beta Blockers
• Hydralazine and Nitrates in combination

Propranolol

Mechanism of Action

• Nonspecific blocker of both Beta-1 and Beta-2 receptors

Indications

• Migraine headaches
• Portal hypertension
• Thyroid storm
• Essential tremor
• Pheochromocytoma (adrenal tumor)

Side-Effects

• Bronchospasm, depression, bradycardia, hypotension, erectile dysfunction
• Hyperkalemia by inhibiting Sodium/Potassium ATPase
• Adverse effects on glucose and peripheral arterial disease

Adenosine

Indication

• Supra ventricular tachycardia that does not respond to sinus massage

Mechanism of Action

• Reduces calcium currents and is anti-arrhythmic by increasing AV nodal refractoriness
• Transiently slows sinus rate and AV nodal conduction velocity
• Opens potassium channels, hyperpolarizing nodal tissue and making them less likely to fire

Aspirin

Mechanism of Action

• Irreversibly inhibits COX, decreasing TXA2 production and preventing clot formation

Indications

• Acute coronary syndromes (MI, unstable angina)
• Stroke or TIA
• Peripheral artery disease
• Kawasaki's Disease
• Essential Thrombocythemia
• Fever, RA, Gout

Adverse Effects

• Bleeding
• Peptic ulcers, asthma, renal insufficiency, rash

Toxic Overdose

• Metabolic acidosis
• Tinnitus
• Encephalopathy
• Renal insufficiency
• Increased anion gap

Dipyridamole

Indications

• Thinning blood in patients with stroke, heart valve embolism, or peripheral artery disease
• Diagnostic tool in myocardial perfusion studies

Mechanism of Action

• Inhibits adenosine deaminase and phosphodiesterase
• Increases cAMP, inhibiting platelets

Adverse Effects

• Dizziness, headache
• GI bleeds

Thienopyridines

Examples

• Clopidogrel
• Prasugrel
• Ticlopidine

Mechanism of Action

• Act as blood thinners by inhibiting platelet aggregation

Indications

• Combination with aspirin is standard treatment for acute MI
• Strongest indication is early coronary intervention (angioplasty) with stenting

This quiz covers the indications of spironolactone and eperenone, as well as medications that lower mortality in congestive heart failure. It's a high-yield topic for medical students.