What major adverse effect should a nurse highlight when teaching about spironolactone?

Spironolactone is a potassium-sparing diuretic that primarily acts on the distal convoluted tubule and collecting ducts in the kidneys. Its mechanism of action involves antagonism of the aldosterone receptor, which promotes sodium and water reabsorption while causing potassium retention. Therefore, one of the most significant adverse effects to monitor when using spironolactone is hyperkalemia, which is an elevated level of potassium in the blood.

Hyperkalemia is particularly concerning because elevated potassium levels can lead to serious cardiovascular complications, including arrhythmias. The risk of hyperkalemia increases in patients with conditions that impair kidney function, those taking other medications that increase potassium levels, and in individuals who consume high-potassium diets. Hence, when educating patients about spironolactone, it’s essential for nurses to stress the importance of monitoring potassium levels and recognizing signs and symptoms of hyperkalemia, such as muscle weakness, fatigue, palpitations, and changes in heart rhythm.

In contrast, dehydration and volume depletion are more common concerns associated with other types of diuretics that promote fluid loss, while hypokalemia is typically a risk associated with thiazide and loop diuretics, which enhance potassium excretion.