To view this video, please enable marketing cookies from Cookie Preferences in the footer.
In this This Is Why with Dr. Busti pharmacology review, Dr. Busti unpacks the mechanisms, clinical relevance, and evolution of mineralocorticoid receptor antagonists (MRAs)—a class that reshaped the management of heart failure, resistant hypertension, and cirrhosis. From the landmark RALES and EPHESUS trials to the emergence of selective agents like finerenone, he connects the evidence to the underlying physiology, explaining how MRAs influence cardiac remodeling, renal function, and survival outcomes.
Listeners will gain a clear understanding of spironolactone, eplerenone, and finerenone, how structural differences drive their selectivity and side effect profiles, and what to monitor to ensure safe, effective therapy.
Access bonus materials and downloads at https://thisiswhy.health
Disclaimer: This content is for educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard in this content.
Chapter Table of Contents
00:00 – Introduction | Understanding MRAs and their clinical evolution
02:55 – Why MRAs Matter | Mortality benefits in heart failure & hypertension
06:05 – Drug Class Overview | Spironolactone · Eplerenone · Finerenone
09:40 – Indications & Uses | Heart failure · CKD · Ascites · Hyperaldosteronism
13:55 – Mechanism of Action | Blocking aldosterone & sodium-water retention
17:10 – Renal Perfusion & Anatomy | How kidney blood flow impacts efficacy
20:45 – The Nephron in Context | Where MRAs act in the distal nephron
24:50 – Receptor Selectivity | Steroidal vs nonsteroidal binding differences
29:15 – Pharmacokinetics | Absorption, distribution & CYP3A4 metabolism
33:25 – Structural Chemistry | How design reduces side effects like gynecomastia
37:40 – Clinical Trial Evidence | RALES · EPHESUS · FIDELIO-DKD
41:05 – Side Effects | Hyperkalemia, endocrine changes, dose considerations
44:20 – Drug Interactions | CYP3A4 inhibitors, ACEi/ARB & NSAID impacts
47:55 – Monitoring & Labs | Potassium · Renal function · Blood pressure
51:20 – Patient Counseling | Salt substitutes, polypharmacy & education
55:25 – Clinical Pearls | Balancing risk and benefit in heart failure care
59:45 – Closing Thoughts | Evidence meets understanding in MRA therapy
More than just access—it’s where understanding deepens.
Create a free account or log in to gain access to this content!
