SPIRONOLACTONE

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(speer-on-oh-lak’tone)
Aldactone, Novospiroton 
Classifications: electrolytic and water balance agent; potassium-sparing diuretic
Pregnancy Category: D

NURSING IMPLICATIONS

Assessment & Drug Effects

• Check blood pressure before initiation of therapy and at regular intervals throughout therapy.
• Lab tests: Monitor serum electrolytes (sodium and potassium) especially during early therapy; monitor digoxin level when used concurrently.
• Assess for signs of fluid and electrolyte imbalance, and signs of digoxin toxicity.
• Monitor daily I&O and check for edema. Report lack of diuretic response or development of edema; both may indicate tolerance to drug.
• Weigh patient under standard conditions before therapy begins and daily throughout therapy. Weight is a useful index of need for dosage adjustment. For patients with ascites, physician may want measurements of abdominal girth.
• Observe for and report immediately the onset of mental changes, lethargy, or stupor in patients with liver disease.
• Adverse reactions are generally reversible with discontinuation of drug. Gynecomastia appears to be related to dosage level and duration of therapy; it may persist in some after drug is stopped.

Patient & Family Education

• Be aware that the maximal diuretic effect may not occur until third day of therapy and that diuresis may continue for 2–3 d after drug is withdrawn.
• Report signs of hyponatremia or hyperkalemia (see Appendix F), most likely to occur in patients with severe cirrhosis.
• Avoid replacing fluid losses with large amounts of free water (can result in dilutional hyponatremia).
• Weigh 2–3 times each week. Report gains/loss of 5 lbs.
• Do not drive or engage in potentially hazardous activities until response to the drug is known.
• Avoid excessive intake of high-potassium foods and salt substitutes.
• Do not breast feed while taking this drug.

 

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