spironolactone Nursing Considerations & Management

Drug Name

Generic Name :  spironolactone

Brand Name: Aldactone, Novospiroton (CAN)

Classification: Potassium-sparing diuretic, Aldosterone antagonist

Pregnancy Category D 

Dosage & Route

Available forms : Tablets—25, 50, 100 mg

ADULTS
  • Edema: Initially, 100 mg/day (range 25–200 mg/day) when given as the sole agent; continue > 5 days, then adjust dose or add another diuretic or both.
  • Diagnosis of hyperaldosteronism: 400 mg/day PO for 3–4 wk (long test). Correction of hypokalemia and hypertension are presumptive evidence of primary hyperaldosteronism. 400 mg/day PO for 4 days (short test). If serum K+ increases but decreases when drug is stopped, presumptive diagnosis can be made.
  • Maintenance therapy for hyperaldosteronism: 100–400 mg/day PO.
  • Essential hypertension: 50–100 mg/day PO. May be combined with other diuretics.
  • Hypokalemia: 25–100 mg/day PO.
PEDIATRIC PATIENTS
  • Edema: 1–3.3 mg/kg/day PO adjusted to patient’s response, administered as single or divided dose.
Therapeutic actions
  • Spironolactone acts on the distal renal tubules as a competitive antagonist of aldosterone. It increases the excretion of sodium chloride and water while conserving potassium and hydrogen ions.
Indications
  • Diagnosis and maintenance of primary hyperaldosteronism
  • Adjunctive therapy in edema associated with CHF, nephrotic syndrome, hepatic cirrhosis when other therapies are inadequate or inappropriate
  • Treatment of hypokalemia or prevention of hypokalemia in patients who would be at high risk if hypokalemia occurred: Digitalized patients, patients with cardiac arrhythmias
  • Essential hypertension, usually in combination with other drugs
  • Unlabeled uses: Treatment of hirsutism due to its antiandrogenic properties, palliation of symptoms of PMS, treatment of familial male precocious puberty, short-term treatment of acne vulgaris
Adverse effects
  • Fluid or electrolyte imbalance, gynecomastia, GI upset, drowsiness, headache, hyponatremia; tachycardia, hypotension, oliguria, hyperkalemia; confusion, weakness, paresthesia, hirsutism, mental disturbances, menstrual irregularities, loss of libido and impotence.
  • Potentially Fatal: Fatal hyperkalemia in combination with ACE inhibitors and previous renal impairment; agranulocytosis.
Contraindications
  • Anuria, hyperkalemia, acute or progressive renal insufficiency. Addison’s disease.
Nursing considerations
Assessment
  • History: Allergy to spironolactone; hyperkalemia; renal disease; pregnancy, lactation
  • Physical: Skin color, lesions, edema; orientation, reflexes, muscle strength; P, baseline ECG, BP; R, pattern, adventitious sounds; liver evaluation, bowel sounds; urinary output patterns, menstrual cycle; CBC, serum electrolytes, renal function tests, urinalysis
Interventions
  • Mark calendars of edema outpatients as reminders of alternate day or 3- to 5-day/wk therapy.
  • Give daily doses early so that increased urination does not interfere with sleep.
  • Make suspension as follows: Tablets may be pulverized and given in cherry syrup for young children. This suspension is stable for 1 mo if refrigerated.
  • Measure and record regular weight to monitor mobilization of edema fluid.
  • Avoid giving food rich in potassium.
  • Arrange for regular evaluation of serum electrolytes and BUN.
Teaching points
  • Record alternate-day therapy on a calendar, or prepare dated envelopes. Take the drug early because of increased urination.
  • Weigh yourself on a regular basis, at the same time and in the same clothing, and record the weight on your calendar.
  • Avoid foods that are rich in potassium (fruits, Sanka); avoid licorice.
  • You may experience these side effects: Increased volume and frequency of urination; dizziness, confusion, feeling faint on arising, drowsiness (avoid rapid position changes, hazardous activities: such as driving, using alcohol); increased thirst (suck on sugarless lozenges; use frequent mouth care); changes in menstrual cycle, deepening of the voice, impotence, enlargement of the breasts can occur (reversible).
  • Report weight change of more than 3 pounds in 1 day, swelling in your ankles or fingers, dizziness, trembling, numbness, fatigue, enlargement of breasts, deepening of voice, impotence, muscle weakness, or cramps.
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