Verospiron 50mg- suy tim

1 2 3 4 Sinh l hc suy tim c im ca Verospiron Cc nghin cu lm sng Thng tin k toa Verospiron

nh ngha v dch t hc
nh ngha: Suy tim l tnh trng tim khng cung cp mu p ng c nhu cu ca c th do nhng bnh l lm bin i cu trc v chc nng ca tim Tn sut gp: 1% nhng ngi 50 tui 10% nhng ngi 80 tui Nam mc nhiu hn n, tng theo tui

Vai tr ca Aldosterone trong Suy tim

Aldosteron e
x
Na+ ho v khi tht tri K+ Mg++ Fibrosis hp thu Norepinephrine t l n hi ca tim Lon nhp tim Arterial compliance Baroreceptor function Hp thu Norepinephrine Chc nng ni m PAI-1 Gy thiu mu cc b

Ph

Ti cu trc

Progression of HF

Cht t t do bnh tim

Ngn gi mui nc Suy tim tin trin Ngn x ha c tim

Khng aldosteron (Verospiron )

Ngn mt kali t t Loan nhp tim

Verospiron (Spironolacton) thuc khng Aldosteron

Thuoc khang aldosteron manh e ieu tr va phong nga suy tim

Phn nhm
Thiazides
Hydrochlorothiazide (Apo-Hydro) Chlorthalidone (Hygroton) Chlorothiazide (Diuril) Indapamide (Natrilix SR, Fludex, Dapatabs, Lorvas) Metolazone (Zaroxolyn)

Loop Diuretics
Furosemide (Lasix, Trofurit, Furosemide), Bumetanide (Bumex), Ethacrynic acid (Edecrin) Torsemide (Demadex)

Potassium Sparing Spironolactone (Verospiron) == Amiloride (Midamor) Triamterene (Dyrenium)

carbonic anhydrase Sulfamid

Li tiu thm thu, Nhm Xanhtin Manitol,..

Suy tim: gim t sut, ci thin suy tim Cng Aldosterone th Ph:Suy tim
X gan. pht. Ph khng vi i chng ithn h. H thuc l tiu khc dng

ng dng iu tr ca VEROSPIRON

Bnh cng Aldosterone Tng huyt p v cn. Gim Kali mu do thuc li tiu

CC NGHIN CU V VEROSPIRON TRONG BNH L TIM MCH

RALES: thit k nghin cu

Suy tim NYHA III, IV LVEF 35% ACEI + Li tiu quai digoxin Spironolactone 25 50 mg/day* (n = 822) Tiu ch nh gi hng u T l t vong 3 nm Placebo (n = 841)

Nhng tiu ch khc Nhp vin do suy tim T vong do tim mch Ci thin NYHA

Pitt B, Zannad F, Remme WJ, et al. N Engl J Med. 1999;341:709-717. *Protocol used a starting dose of 25 mg/day whereas the mean daily dose was 25 mg.

LVEF: left ventricle ejection fraction

RALES: T vong do mi nguyn nhn

Probability of survival 0.95
0.90 0.85 0.80 0.75 0.70 0.65 0.60 0.55 0.50 0.45 0 3 6 1.00

Gim nguy c t vong 30% P<0.001 Spironolactone + CMC

Liu php tiu chun (UCMC + li tiu quai digoxin) Thng 9 12 15 18 21 24 27 30 33 36

Pitt B, Zannad F, Remme WJ, et al. N Engl J Med, 1999;341:709717.

RALES: T vong do tim mch + iu tr Probability ni tr

of event
1.00 0.95 0.90 0.85 0.80 0.75 0.70 0.65 0.60 0.50 0.55 Liu php tiu chun 0.45 0 3

Gim nguy c 31% P<0.001

Spironolactone + Liu php tiu chun

(UCMC + li tiu quai digoxin)

6 9 12 15 18 21 24 27 30 33 36

Month s

Pitt B, Zannad F, Remme WJ, et al. N Engl J Med, 1999;341:709-717.

RALES: NYHA trc v sau iu tr

50 40 30 Percent of patients 20 10 0 48% 399 38% 305 p = 0.001 33% 277 18% 153 21% 169 Placebo+liu php chun Spironolactone+liu php chun 41% 335

tt B, Zannad F, Remme WJ, et al. N Engl J Med. 1999;341:709-717.

Xu i

Khng thay i

Ci thin

RALES: kt lun
Gim t vong do mi nguyn nhn 30% (P<0,001)

Gim t vong do nguyn nhn tim mch 31% (P<0,001) Gim nhp vin do suy tim 35% (P<0,001)

Verospiron kt hp v thuc UCMC c li ch rt ng k i vi bnh nhn suy tim NYHA III, IV.

Pitt B, Zannad F, Remme WJ, et al. N Engl J Med, 1999;341:709-717.

NGHIN CU
nh hng lu di v ph thuc liu ca Verospiron trn chc nng tht tri v Liu php gng sc Bnh nhn Suy tim mn tnh
Tiu ch nh ga: -LVESV, VO2 - Liu Verospiron t kt qu ti u
Journal of American College of Cardiology 2002 by American College of Cardiology Foundation Published by Elsevier Science Inc.

Th tch tht tri cui tm thu gim

Control group (n= 46)
Variable B aseline Follow-up 168+/- 69 253+/- 89

Spironolacton (n= 47)

B aseline 188+/- 94 Follow-up 171+/- 97 *

LVESV (ml) 173+/- 71 LVEDV (ml) 257+/-80 * p< 0,01

275+/- 104 251+/- 105*

Kt qu Siu m tim ca nghin cu ti im bt u v sau 12 thng

CI THIN V KH NNG GNG SC

Control group (n= 46)
Variable B aseline Follow-up

Spironolacton (n= 47)

B aseline Follow-up

Peak VO2 18,5+/(ml/min/kg) 5,5

17,8+/- 5,3 16,4+/- 4,8 16,8+/- 4,9 *

* p< 0,01

Kt qu v nhng bin vn ng ca qun th nghin cu ti im c bn v sau 12 thng

Tm lc (1)
Th tch v chc nng tm thu tht tri trn bnh nhn suy tim mn tnh ci thin r rt nht liu 50 mg
S c i t h i n p h n s t n g m u t h t t 4 3 .5 3 2 .5 2 1 .5 1 0 .5 0 C o n tr o ls 25 mg
L i u i u tr

50 mg

Journal of American College of Cardiology 2002 by American Clloege of Cardiology Foundation Published by Elsevier Science Inc.

Journal of American College of Cardiology 2002 by Amican Clloege of Cardiology Foundation Published by Elsevier

Tm lc (2)
Th tch hp th O2 cc i khi gng sc
S ci thin khnng hp th Oxyc i khi gngs theo liu c c iu tr

ci thin tt nht liu Verospiron 50 mg

0.6 0.4 0.2 0 -0.2 -0.4 -0.6 -0.8 -1 -1.2 -1.4

C ontrols

25m g

50m g

Liul ng

Journal of American College of Cardiology 2002 by American Clloege of Cardiology Foundation Published by Elsevier Science Inc

Journal of American College of Cardiology 2002 by Amican Clloege of Cardiology Foundation Published by Elsevier

Nghin cu Khoa iu tr tng Huyt p, Bnh Vin Broussais, Paris Php Am J Cardiol 1987; 60: 820 - 825 Tiu ch nh gi: Nng K huyt tng Men n 51 Age 529 Dose(mg) 118 68 mg(kg) 1.5 0.9 Duration (day) 621 632 Range 92 3.300 Before After Blood Pressure (mmHg) 142.1 Systolic 166.7 22.3 20.1 Diastolic 103.3 12.4 88.5 11.1 Body weight (kg) 79.3 13.4 78.8 12.9 Plasma values (mmol/l) Creatinine (mol/l) 92.9 16.4 99.5 22.7 Postassium 3.5 0.5 4.3 0.5 Uric acid (mol/l) 361 74 365 80 Glucose 5.6 0.7 5.9 1.2 Cholesterol 6.2 1.2 6.2 1.2 Triglycericdes 1.3 0.5 1.4 0.6

Women 131 5411 88 42 1.5 0.9 718 650 90 3.240 Before After 161.0 145.717. 20.2 6 96.1 88.0 11.2 9.90 61.5 60.1 11.7 11.1 76.7 85.9 14.8 18.3 3.7 0.4 4.2 0.4 297 70 310 71 5.2 0.6 5.3 0.6 6.3 1.1 6.2 1.0 1.1 0.5 1.2 0.6

Thng tin k toa

Liu dng Chng ch nh
g 50m on spir Vero Thn trng

Tng tc thuc

Tc dng khng mong mun

Suy tim: 50-100mg/ngy

0 giam t vong va bao ve tim mach trong phong nga va ie

V niu. Suy thn cp. Suy thn nng. Tng Kali huyt. Co thai hoc ang cho con bu.

CHNG CHI INH VEROSPIRON

0 giam t vong va bao ve tim mach trong phong nga va ie

THN TRONG VEROSPIRON Suy thn v tng Kali huyt. Nu s dung ng thi vi thuc

thay th Kali thi phai thng xuyn kim tra nng Kali huyt.

0 giam t vong va bao ve tim mach trong phong nga va ie

TNG TAC THUC

Salicylate lam giam tac dung li tiu. Lam tng tac dung li tiu cua cac thuc li tiu khac. Nguy c lam tng Kali huyt khi dung ng thi vi K+ v cac thuc li tiu gi K+ khac. 0 Lam tng va bao ve Digoxin. giam t vong T/2 cua tim mach trong phong nga va ie

TAC DUNG PHU

iu tri bng Verospiron liu cao (>300mg/ngy) v lu dai co th gy tng kali huyt. Co th gp nn ma, bun nn, tiu chay, bun ngu. Nhng phan ng phu nay se mt i khi ngng thuc.

0 giam t vong va bao ve tim mach trong phong nga va ie

KT LUN
VEROSPIRON 50mg

Ci thin chc nng tht tri v th tch hp th oxi cc i, hiu qu trong iu tr suy tim mn tnh

Kt hp vi UCMC gip gim t sut do bnh tim mch v cc nguyn nhn khc (nghin cu RALE)

Chn thnh cm n! Thank you for your attention!