SIDE EFFECTS Eplerenone Most Common
( e h - P L E H - r e h - n o n e )
Hyperkalemia, diarrhea, abdominal pain, diz-ziness, coughing, fatigue, flu-like symptoms. Classification(s): Aldosterone receptor
Hyperkalemia is the primary risk; can result in de-
creased renal function and serious, sometimes fa- tal arrhythmias. GI: Diarrhea, abdominal pain. Pregnancy Category: B GU: Mastodynia in males, abnormal vaginal RX: Inspra.
bleeding, gynecomastia (males). Miscellaneous: Dizziness, coughing, fatigue, flu-like symptoms. INDICATIONS/USES LABORATORY TEST CONSIDERATIONS
(1) Hypertension, alone or in combination withother antihypertensive drugs. (2) Improve survival
e ALT, BUN, uric acid, serum creatinine. Hypo-
of stable clients with left ventricular systolic dys-
natremia, hypercholesterolemia, albuminuria, hy-
function (ejection fraction of 40% or less) and
clinical evidence of CHF after an acute MI. Inves-DRUG INTERACTIONS tigational: Alone or in combination with an angio-
ACE inhibitors / e Risk of hyperkalemia
tensin-converting enzyme inhibitor for reducing
Angiotensin II antagonists / e Risk of hyperkale-
left ventricular hypertrophy. As adjunctive therapy
in diabetic hypertension with microalbuminuria. CYP3A4 inhibitors (itraconazole, ketoconazole) /
ACTION/KINETICS
Up to a 5-fold increase in eplerenone exposureLithium / Potential lithium toxicity; monitor se-
Binds to the mineralocorticoid receptor and
NSAIDs / Potential a antihypertensive effect and
blocks binding of aldosterone. Aldosterone in-
creases BP through induction of sodium reabsorp-
h St. John’s wort / About a 30% a in eplere-
tion and other mechanisms. Thus, by blocking
aldosterone binding, sodium is not reabsorbedand BP decreases. HOW SUPPLIED Pharmacokinetics Peak plasma levels: About 1.5 hr. Steady state: Reached in 2 days. Absorption not affected by
food. Metabolized primarily via CYP3A4 in theliver. About two-thirds excreted in the urine and
one-third in the feces. t1/2, terminal: 4–6 hr. Plas- ma protein binding: About 50%. Initial: 50 mg once daily. If inadequate response, increase dose to 50 mg twice a CONTRAINDICATIONS
Serum potassium greater than 5.5 mEq/L at initi-
ation, type 2 diabetes with microalbuminuria, se-
rum creatinine greater than 2 mg/dL in males or
30 mL/min. Also, clients concurrently taking po-
tassium supplements, potassium-sparing diuretics
(e.g., amiloride, spironolactone, triamterene), or
Left ventricular systolic dysfunction and clinical
strong inhibitors of CYP3A4 drugs (clarithromy-
evidence of conjestive heart failure after an
cin, ketoconazole, itraconazole, nefazodone, nelfi-
navir, ritonavir, troleandomycin). Lactation. Initial: 25 mg once daily; titrate to tar- get dose of 50 mg once daily, preferable SPECIAL CONCERNS
Safety and efficacy not determined in children.
um. Less than 5 mEq/L potassium:
nine >2.0 mg/dL in males or >1.8 mg/dL in
day to 25 mg daily to 50 mg daily; Se- 4. Assess BP, serum K+, renal and LFTs, and for rum potassium from 5–5.4 mEq/L:
DM. With post-MI heart failure, note LV ejec-
Maintain dosage; no adjustment; Se-
tion fraction and systolic dysfunction. rum potassium, 5.5–5.9 mEq/L: De- CLIENT/FAMILY TEACHING 1. Take as directed with or without food. Do not
take supplements containing potassium.
holding the drug; Serum potassium, 6 mEq/L or greater: Withhold drug. 2. Avoid activities that require mental alertness
until drug effects realized. Sit or lie down if
experiencing dizziness or lightheadedness
NURSING IMPLICATIONS
when standing. Keep log of BP and HR. 3. Continue lifestyle changes that help control IMPLEMENTATION/ADMINISTRATION/STORAGE
BP, i.e., maintain healthy diet and limit intake
1. Dosage adjustment is not necessary for mild
of caffeine, avoid alcohol, salt substitutes, or
to moderate hepatic dysfunction. Should notbe used in those with severe hepatic dysfunc-
high Na+ and high K+ foods, perform regular
exercise, maintain weight, and stop smoking. 2. Store from 15–30°C (59–86°F). 4. Avoid OTC meds and ETOH. 5. Keep all F/U to assess response, labs, and ASSESSMENT 1. Note reasons for therapy, symptom character- OUTCOMES/EVALUATE 2. List drugs prescribed to ensure none interact. 3. With HTN, avoid drug use in type 2 diabetes
with microalbuminuria, and if serum creati-
A comparative review of the effectiveness of hypnosis, an advanced method of hypnosis, and other interventions used for the cessation of smoking Prepared for Stop Smoking in One Hour™ by Michael O' Driscoll B.Sc., M.Sc. (Oxon) Contents What's the problem?: Smoking - the biggest cause of preventable death in the developed world .3 2. Hypnosis and other interventions for smoking cessation .
The Rules have Changed The management of electronic research records is more important than ever before Michael H Elliott Published in Scientific Computing May 2007 A patent provides rights to an inventor to restrict The use of Electronic Laboratory Notebook (ELN) the ability of others to make, use, or sell an technology has risen sharply in the past four years, invention. To obtain a pa