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Related Concept Videos

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
Renal Drug Excretion: Overview01:15

Renal Drug Excretion: Overview

As primary excretory organs, the kidneys maintain homeostasis by removing waste substances from the bloodstream. They comprise over a million units called nephrons, which serve as the kidney's functional units.
A nephron consists of two primary structures: the renal corpuscle and the renal tubule. The renal corpuscle contains the glomerulus, a network of capillaries where the first step of renal excretion, glomerular filtration, occurs. Blood pressure forces water, ions, and small molecules out...
Treatment for Pulmonary Arterial Hypertension: Endothelin Receptor Antagonists01:18

Treatment for Pulmonary Arterial Hypertension: Endothelin Receptor Antagonists

Endothelins (ETs) are potent vasoactive peptides critical in the human body's various physiological and pathological processes. One of the most promising therapeutic strategies for treating pulmonary arterial hypertension (PAH) involves counteracting the effects of these endothelins using a class of drugs known as endothelin receptor antagonists.
ETs are synthesized through a complex sequence of enzymatic steps, primarily involving an enzyme referred to as endothelin-converting enzyme (ECE). Of...
Antihypertensive Drugs: Direct Renin Inhibitors01:25

Antihypertensive Drugs: Direct Renin Inhibitors

The renin-angiotensin-aldosterone system (RAAS) is an intricate physiological pathway involving numerous enzymes and hormones, including renin, angiotensin-converting enzyme (ACE), angiotensin I and II, and aldosterone. Imbalances within this system increase the production of angiotensin II and aldosterone. Increased angiotensin II levels promote vasoconstriction and blood pressure elevation. Concurrently, higher aldosterone levels stimulate sodium and water reabsorption in the kidneys,...
Renal Drug Excretion: Tubular Secretion01:28

Renal Drug Excretion: Tubular Secretion

Active tubular secretion is a robust, energy-demanding process that utilizes carrier systems to transport drugs into renal tubules. The active renal secretion systems include the organic anion transporter (OAT) for weak acids and the organic cation transporter (OCT) for weak bases. Structurally similar drugs can compete for the same transporter, potentially leading to drug accumulation and toxicity. However, this principle can be exploited therapeutically. One example is probenecid (Probalan),...
Renal Drug Excretion: Tubular Reabsorption01:25

Renal Drug Excretion: Tubular Reabsorption

Tubular reabsorption, a process occurring post-glomerular filtration of drugs in the renal tubule, is a critical determinant of drug half-life. During the process of renal excretion, as the glomerular filtrate progresses to the distal convoluted tubule (DCT), drugs that are highly permeable, lipophilic, and nonionized undergo passive reabsorption from the tubular fluid into the surrounding peritubular capillaries. This reabsorption process restricts their elimination through the kidneys. This...

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Related Experiment Video

Updated: May 18, 2026

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
08:35

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion

Published on: May 26, 2022

Ethics and eplerenone.

Shruti Gupta1, Adriane J Fugh-Berman, Anthony Scialli

  • 1Department of Pharmacology and Physiology, Georgetown University Medical Center, Washington DC, USA.

Journal of Medical Ethics
|September 28, 2012
PubMed
Summary
This summary is machine-generated.

Using an inactive placebo in clinical trials is unethical if a safe and effective inexpensive alternative exists. Trials must include cost-effective comparators to avoid unnecessary medical expenses and protect participants.

Related Experiment Videos

Last Updated: May 18, 2026

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
08:35

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion

Published on: May 26, 2022

Area of Science:

  • Clinical trial ethics
  • Medical economics
  • Evidence-based medicine

Background:

  • The ethical use of placebo comparators in clinical trials is debated.
  • Active comparators are preferred when safe and effective alternatives exist.
  • Expensive therapies may bypass testing against cheaper, established treatments.

Purpose of the Study:

  • To argue that inactive placebos are unethical if a safe, effective, inexpensive alternative comparator is available.
  • To advocate for the inclusion of inexpensive therapies as comparators in clinical trials.
  • To highlight the ethical responsibility to avoid unnecessary medical costs.

Main Methods:

  • Ethical argumentation based on principles of non-maleficence.
  • Analysis of clinical trial design and comparator selection.
  • Case example: eplerenone vs. spironolactone for heart failure.

Main Results:

  • Clinical trials using expensive drugs should include inexpensive, effective alternatives as comparators.
  • Excluding known effective, inexpensive therapies from trials is ethically problematic.
  • This practice can lead to unnecessary healthcare costs and exploitation of trial participants.

Conclusions:

  • Ethical clinical trial design necessitates the inclusion of cost-effective comparators.
  • Avoiding unnecessary medical expenditure is a key ethical consideration.
  • Stakeholders must ensure trials prioritize patient welfare and responsible resource allocation over promoting expensive therapies.