Spironolactone

INTRODUCTION

Indications

Management of primary hyperaldosteronism. Management of edema associated with congestive heart failure, cirrhosis, and nephrotic syndrome. Management of essential hypertension. Treatment of hypokalemia (counteracts potassium loss caused by other diuretics).

Action

Causes loss of sodium bicarbonate and calcium while saving potassium and hydrogen ions by antagonizing aldosterone. Therapeutic Effects: Weak diuretic and antihypertensive responses when compared with other diuretics. Conservation of potassium.

Adverse Reactions/Side Effects

CNS: dizziness, clumsiness, headache. CV: arrhythmias. GI: GI irritation. GU: erectile dysfunction, dysuria. Endo: gynecomastia (in males), breast tenderness, deepening of voice, increased hair growth (in females). F and E: hyperkalemia, hyponatremia, hyperchloremic metabolic acidosis. Hemat: agranulocytosis. MS: muscle cramps. Misc: allergic reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of fluid, electrolyte, or acid-base imbalances, including dizziness, clumsiness, drowsiness, headache, blurred vision, confusion, hypotension, or muscle cramps and weakness. Report excessive or prolonged symptoms to the physician.

• Assess dizziness and clumsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess blood pressure periodically and compare to normal values (See Appendix F) to help document antihypertensive effects.

• When used to treat edema, help determine drug effects by assessing peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Also monitor signs of pulmonary edema such as dyspnea and rales/crackles (See Appendix K). Document whether peripheral and pulmonary symptoms are controlled adequately by diuretic therapy.

• Monitor signs of allergic reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

Interventions

• Implement fall-prevention strategies, especially in older adults or if patient exhibits sedation, dizziness, clumsiness, or other impairments that affect gait and balance (See Appendix E).

• Use caution during aerobic exercise, especially in hot environments. Increased sweating will cause fluid and electrolyte loss, and may exaggerate arrhythmias and diuretic side effects (dizziness, muscle cramps, and so forth).

• To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.

Patient/Client-Related Instruction

• Remind patients to take medication as directed to control hypertension and other cardiac conditions even if they are asymptomatic.

• Counsel patients about additional interventions to help control blood ...