Why 2 diuretics (Lasix and Spirnolactone) for CHF?

[discobunni]

I don't understand why most people with CHF are on Lasix and Spirnolactone when they have the same mechanism of action on the distal tubule, is it because the Spirno is potassium sparing and the Lasix also works on the loop of henle? Help.

[Tweety, BSN, RN]

Will move to the genreal nursing forum since anyone can answer the question. Good luck in getting help.

[oMerMero]

Spirolactone is used in class III or IV heart failure patients. Potassium sparing diuretics have been shown to reduce mortality, reduce hospitalizations, and improve sypmtoms of heart failure. Loop diuretics work much better at removing fluid, but sometimes more fluid needs to be removed, and with spirolactone, there is less potassium and magnesium removed.

[SuesquatchRN, BSN, RN]

Spironolactone acts to suppress aldosterone, which is the first hormone released in the aldosterone - renin - angiotensin cycle. It helps nip the production of ADH in the proverbial bud rather than act within the kidneys themselves.

[Freedom42]

Spironolactone blocks the actions of aldosterone in the distal nephron, so potassium is retained and sodium is excreted. Furosemide used alone poses a risk of hypokalemia, which can lead to dysrhythmia.

[steelcityrn, RN]

I do not see "most " patients with chf on both. Great answers on the mechanisms above.

[RN1980]

the main reason is that diuretic therapy with lasix can get pretty devastating on your kidneys and electrolyte balance when dealing with a patient in bad chf that may require alot of huge and frequent doses from lasix. now, lasix is great at getting fluid off, but like the others in their post have stated it's hard on the patient in large dosages. now the reason for the spironolactone, is that the patient may very well still need some more additional fluid removed and the doc's really don't want to hit him with extra lasix ( to prevent anymore complications as mentioned from lasix therapy) since spironolactone has a musch lesser affect on the bun/creat and electrolytes than lasix they'll use some spironolactone instead of a larger dose of lasix, hence you may see a order like this= lasix 20mg q day, spironalactone 25mg po bid....just remember lasix will really get the fluid off and fast but rough on your system, spironalactone not as fast as lasix but easier on your body.

[SuesquatchRN, BSN, RN]

Thanks, RN1980. I always forget that Lasix (furosemide) is nephrotoxic.