Paper I — 2018 July (Supplementary) (2010 Scheme) — Q4

Paper I

2018 July (Supplementary) (2010 Scheme) · 40 marks · 120 min

Question

Spironolactone

Q43 marksShort Notes★✓

Answer

Spironolactone is a potassium-sparing diuretic (aldosterone antagonist).

Mechanism of action

• Competitively antagonizes aldosterone receptors in the distal tubule/collecting duct
• Prevents aldosterone-mediated Na⁺ reabsorption and K⁺/H⁺ secretion — mild natriuretic effect with potassium retention

Uses

• Primary hyperaldosteronism (Conn’s syndrome)
• Oedema associated with hepatic cirrhosis/nephrotic syndrome/congestive cardiac failure (particularly effective in secondary hyperaldosteronism states)
• Chronic heart failure (improves survival at low doses, as an adjunct — blocks aldosterone-mediated cardiac fibrosis)
• Resistant hypertension
• Hirsutism (antiandrogen effect, off-label)

Adverse effects

• Hyperkalaemia (major risk, especially with ACE inhibitors/renal impairment)
• Gynaecomastia, menstrual irregularities (antiandrogenic/progestogenic effects)
• GI upset

Related Concepts

1. 1Renal Pharmacology

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