USMLE Step 1

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Pharmacology

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Cardiovascular Pharm

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Sacubitril

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Summary

Lorem

Key Points

  • Sacubitril
    • Mechanism
      • Inhibits neprilysinincreases ANP
        • Neprilysn is an endogenous endopeptidase that breaks down and inactivates various peptide hormones
        • Also increases levels of BNP, angiotensin II, bradykinin, glucagon, substance P, etc
          • So lots of random side effects
    • Clinical Use
      • Heart Failure with Reduced Ejection Fraction (HFrEF)
        • Increased ANP leads to decreased BP through peripheral vasodilation (blood vessels), natriuresis (inhibiting aldosterone secretion by adrenals), and diuresis (dilates afferent arterioles → increased GFR)
    • Adverse Effects
      • Increases angioedema risk for ACE inhibitors
        • Contraindicated with ACE inhibitors
      • Hypotension
      • Hyperkalemia
      • Cough
      • Dizziness