Page 38 - RxExam's Naplex Theory Review Part-1

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Drug Interactions with ACE Inhibitors and Angiotensin II Receptor Antagonists:

Thiazide and loop Sudden and severe hypotension is reported within the first 1 to 3 hours
diuretics after the initial dose of Ace-Inhibitors or Angiotensin II antagonists in
sodium and water depleted patients.

Potassium sparing Hyperkalemia is reported. Serum potassium concentration should be
diuretics monitored regularly.

Estrogen May cause sodium and water retention. May reduce the antihypertensive
effects of ACE inhibitors and Angiotensin II receptor antagonists.

Tetracycline May form chelation with Quinapril due to its high magnesium content.
Concurrent use may reduce the absorption of Tetracycline by 40%.

NSAIDs and COX-2 In patients who are elderly, volume-depleted or with compromised
Inhibitors renal function, co-administration of NSAIDs, including selective COX-2
inhibitors, with ACE inhibitors or Angiotensin II receptor antagonists
may result in deterioration of renal function, including possible acute
renal failure.

Aldosterone Antagonists and Renin Inhibitor:

Dose Special Notes

Spironolactone 25-200 mg per 1). Spironolactone (Aldactone) is a specific pharmacologic antagonist of
(Tablet) day given in aldosterone, acting primarily through competitive binding of receptors
either single or at the aldosterone-dependent sodium-potassium exchange site in the
divided doses. distal convoluted renal tubule.

2). It is indicated for the treatment of:
I. Primary hyperaldosteronism
II. Edematous conditions associated with:
(a) Congestive heart failure
(b) Cirrhosis of the liver accompanied by edema and/or ascites
(c) Nephrotic syndrome
III. Hypertension, hypokalemia and severe heart failure

3). The following test is employed as an initial diagnostic measure to
provide presumptive evidence of primary hyperaldosteronism while
patients are on normal diets.

Long Test: Spironolactone (Aldactone) is administered at a daily dosage
of 400 mg for three to four weeks. Correction of hypokalemia and
hypertension provides presumptive evidence for the diagnosis of
primary hyperaldosteronism.

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