Reference no: EM133516818

Question

The drug sacubitril, a component in Entresto, that works by initiating vasodilation and causes a reduction in the ECF via sodium excretion. This medication in it's active form is converted to LBQ657, which inhibits the enzyme neprilysin. In the body, the enzyme neprilysin degrades vasoactive peptides including natriuretic peptides such as bradykinin and adrenomedullin. This results in increased levels of those peptides. Natriuretic peptides maintain homeostasis in the heart by causing vasodilation, excreting sodium in the urine, and stimulating diuresis. In heart failure, natriuretic peptides are unable to effectively maintain homeostasis. (Lee, N. S., and Daniels, L. B, 2016). This drug is successful because it increases the level of the peptides which better allow cardiac homeostasis to be achieved and maintained. In heart failure, fluid volume overload is a large problem. The heart has reduced ejection fraction, meaning it cannot successfully circulate the blood through the body. Vasodilation allows the vessels expand so more blood can pass through them, also reducing the pressure in the vessel. The excretion of sodium helps draw fluid out of the circulatory system, thus decreasing the workload. Valsartan, the other drug in Entresto, blocks the effects of angiotensin II at the receptor sites. Angiotensin II causes constriction of blood vessels therefore increasing blood pressure. It also signals the adrenal glands to release aldosterone and in turn signals the pituitary to release ADH which works to prevent water from being excreted in the urine. (Cleveland Medical Clinic, n.d.) This drug ultimately benefits those with hearts failure because its works to reduce the fluid volume by multiple different modes and it causes vasodilation of the vessels which allows BP to be reduced and allows the heart to more effectively circulate blood.