Hypertension & Coronary Artery Disease Q 46 - Gyan Darpan : Learning Portal
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Monday 25 April 2022

Hypertension & Coronary Artery Disease Q 46

When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together, the nurse bases teaching on the knowledge that:
     A. Moderate doses of two different types of diuretics are more effective than a large dose of one type.
     B. This combination promotes diuresis but decreases the risk of hypokalemia.
     C. This combination prevents dehydration and hypovolemia.
     D. Using two drugs increases osmolality of plasma and the glomerular filtration rate.

Correct Answer: B. This combination promotes diuresis but decreases the risk of hypokalemia

Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes electrolyte imbalance. A study in children with severe edema secondary to nephrotic syndrome showed that oral spironolactone in conjunction with intravenous furosemide was safe and helpful in treating these children who had edema with volume expansion.

Option A: Hyperkalemia is an adverse effect of spironolactone. This drug is contraindicated in patients with hyperkalemia and in those at increased risk of developing hyperkalemia. Routine blood work is necessary to evaluate serum potassium levels and any decline in renal function. Additional urine studies to assess kidney function may also be a requirement.
Option C: There are rare reports of spironolactone causing liver toxicity that can manifest as elevations in serum aminotransferases and alkaline phosphatase in a hepatocellular mixed pattern after nearly one month of taking spironolactone, and this resolves over time after discontinuation of the drug.
Option D: It is also contraindicated in patients with renal impairment. As per the 2017 American College of Cardiology heart failure guidelines, patients should not receive spironolactone if their serum creatinine is greater than 2.5 mg/dL in men or greater than 2.0 mg/dL in women, the estimated glomerular filtration rate is less than 30 mL/min, and the serum potassium exceeds 5.0 mEq/L.

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