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New Therapies

New Therapies. Heather Kertland, PharmD. Eplerenone Ultrafiltration CRT. New Agents. Outline. Rales Study. New Engl J Med 1999. Eplerenone (Inspra). A chemical derivative of spironolactone, enhanced selective binding to the mineralocorticoid receptor

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New Therapies

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  1. New Therapies Heather Kertland, PharmD

  2. Eplerenone Ultrafiltration CRT New Agents Outline

  3. Rales Study New Engl J Med 1999

  4. Eplerenone (Inspra) A chemical derivative of spironolactone, enhanced selective binding to the mineralocorticoid receptor minimizing binding to progesterone and androgen receptors

  5. Ephesus trial New Engl J Med 2003;348:

  6. Ephesus

  7. Hyperkalemia New Engl J Med 2004;351:542-51

  8. Rx info Monitoring K+ 48 hours post 1st dose 1,4 and 5 weeks 1 week after any dose change Coverage Common Drug Review (CDR) – do not cover ODB Exceptional Access - Experience AMI, have evidence of heart failure and left ventricular systolic dysfunction (EF <40%) and tried spironolactone but experienced severe symptomatic (painful) gynecomastia.

  9. Ultrafiltration Pts not responding to diuretics Clinic/inpatient setting Results 2 – 3 kg greater weight loss than diuretics, no effect on dyspnea No adverse effects on Serum Cr Anticoagulation is required

  10. SMH experience

  11. SMH Experience

  12. Summary UF is an alternative to diuretics for removing fluid Well tolerated with respect to renal function, although can remove fluid too quickly/too much No known effects on drug concentrations determined to date

  13. Resynchronization Therapy (CRT) Delayed conduction of electrical signal Ventricles do not contract at the same time QRS interval > 120 msec on ECG + HF symptoms + reduced EF

  14. New Engl J Med 2010

  15. Summary Indication is heart failure not bradycardia Can have pacing capabilities Can be combined with ICD Impact on drug therapy Implantation – holding of anticoagulation Post – improvement in symptoms – decrease in furosemide

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