A client is receiving spironolactone to treat hypertension. Which of the following instructions should the nurse provide?
A. “Eat foods high in potassium.”
B. “Take daily potassium supplements.”
C. “Discontinue sodium restrictions.”
D. “Avoid salt substitutes.”
Correct Answer: D. “Avoid salt substitutes.”
Because Spironolactone is a potassium-sparing diuretic, the client should avoid salt substitutes because of their high potassium content. Spironolactone specifically works by competitively blocking aldosterone receptor-mediated action. The effect of the blockade is that sodium reabsorption with water retention does not occur, and there is increased potassium retention.
Option A: Spironolactone belongs to the drug class of mineralocorticoid receptor antagonists, and it is a nonselective antagonist that can bind to androgen and progesterone receptors. Aldosterone, a component of the renin-angiotensin-aldosterone system, binds to its receptors at the distal tubules and collecting duct and causes sodium reabsorption and potassium secretion, increased vascular stiffness and remodeling, and increased cardiac inflammation, fibrosis, and remodeling.
Option B: 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: The client should also avoid potassium-rich foods and potassium supplements. To reduce fluid volume overload, sodium restrictions should continue. Hyperkalemia can be due to spironolactone alone or a synergistic side effect from multiple medications such as beta-blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers that clinicians often prescribe to patients for indications such as hypertension or heart failure.
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