Diuretic potassium-sparing diuretics

STUDENT NAME _____________________________________
MEDICATION __________________________________________________________________________ REVIEW MODULE CHAPTER ___________
CATEGORY CLASS ______________________________________________________________________
ACTIVE LEARNING TEMPLATE:
PURPOSE OF MEDICATION
Expected Pharmacological Action
Complications
Contraindications/Precautions
Interactions
Medication Administration
Evaluation of Medication Effectiveness


Therapeutic Use
Nursing Interventions
Client Education
Spironolactone
diuretic/ potassium-sparing diuretics
Causes loss of sodium bicarbonate and
calcium while saving potassium and
hydrogen ions by antagonizing aldosterone.
-PO (orally)
-Adults: 25– 400 mg/day as a single dose
or 2 divided doses. HF– 25– 50 mg/day.
-Children: Diuretic, hypertension- 1.5– 3.3
mg/kg/day (60 mg/m2 /day) as a single
dose or 2– 4 divided doses.
-Neonates: 1– 3 mg/kg/day divided q 12–
24 hr
-Use with eplerenone increase risk of hyperkalemia; concurrent use contraindicated.
-Increase hypotension with acute ingestion of alcohol, other antihypertensive agents, or nitrates.
-Use with ACE inhibitors, NSAIDs, potassium supplements, angiotensin II receptor antagonists, potassium-sparing
diuretics, angiotensin converting enzyme inhibitors, or cyclosporine increase risk of hyperkalemia.
-Increase lithium excretion.
-Antihypertensive and diuretic effectiveness may be decrease by NSAIDs.
-May increase the effects of digoxin.
-Decrease hypoprothrombinemia effect of oral anticoagulants.
Cholestyramine may increase risk of hyperkalemic metabolic acidosis
-Hypersensitivity
-Anuria
-Acute renal insufficiency
-Significant renal impairment (for patients with heart failure)
-Hyperkalemia
-Addison’s disease
-Concurrent use of eplerenone.
-Drug rash with eosinophilia and systemic symptoms (DRESS)
-Steven-Johnsons syndrome
-Toxic epidermal necrolysis
-GI irritation
-Dysuria
-Hyperkalemia
-Increased survival in patients with severe heart failure (New York
Heart Association class II-IV).
-Weak diuretic and antihypertensive response when compared with
other diuretics.
-Conservation of potassium.
-Assess patient for skin rash frequently during therapy.
Discontinue diuretic at first sign of rash; may be life-threatening.
Stevens-Johnson syndrome or toxic epidermal necrolysis may
develop. Treat symptomatically; may recur once treatment is
stopped.
-Monitor intake and output ratios and daily weight during therapy.
-If medication is given as an adjunct to antihypertensive therapy,
BP should be evaluated before administering.
-Assess patient frequently for development of hyperkalemia
-Monitor BUN, serum creatinine, and electrolytes prior to and
periodically during therapy. May cause serum magnesium, uric
acid, BUN, creatinine, potassium, plasma renin activity, and
urinary calcium excretion levels. May also cause sodium levels.
-Periodic ECGs may be recommended in patients receiving
prolonged therapy.
-Increase in diuresis and decrease in edema while maintaining serum
potassium level in an acceptable range.
-Decrease in BP.
-Prevention of hypokalemia in patients taking diuretics.
-Treatment of hyperaldosteronism.
-Advise patient to notify health care professional if rash, muscle
weakness or cramps; fatigue; or severe nausea, vomiting, or
diarrhea occurs.
-Caution patient to avoid salt substitutes and foods that contain
high levels of potassium unless prescribed by health care
professional.
-May cause dizziness. Caution patient to avoid driving or other
activities requiring alertness until response to medication is
known.
-Reinforce need to continue additional therapies for hypertension
(weight loss, restricted sodium intake, stress reduction,
moderation of alcohol intake, regular exercise, and cessation of
smoking). Medication helps control but does not cure
hypertension.

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