potassium sparing or otherwise known as aldosterone inhibiting um you can flip to that slide so you can just see its site of action so mechanism of action it blocks aldosterone receptors and it acts on the distal tubule okay so it basically blocks or interferes with sodium and potassium exchange and again blocks those aldosterone receptors and so by doing that we have increased sodium and h2o excretion right we're getting rid of that while we're still able to retain um potassium which is and hydrogen so those are that's important so when you think of a potassium sparing diuretic that's the first thing that you should think of is we're getting rid of sodium and water but we're able to retain and hold on to the potassium and so when you're looking at it being aldosterone inhibiting so you want to remember and think back to well what is aldosterone and what does it do why would it inhibit it so remember aldosterone is a steroid hormone that is actually produced by those adrenal glands and it's essential for sodium conservation in the kidneys so remember wherever sodium is water is going to follow so if we are conserving sodium we're conserving water so we're holding on to all of that right so it's going to promote the retention of sodium and water and aid in the excretion of potassium that's the normal role of aldosterone so if it's aldosterone inhibiting we basically have the opposite effect of that right so we're not conserving sodium and water right and we're not excreting potassium so therefore it's potassium sparing okay all right so therapeutic effects we have diuresis with less potassium excretion and again it blocks the effects of aldosterone so basically the process i just explained right so we have sodium and water excretion but we have potassium retention we're holding on to more potassium indication why would we give it well maybe somebody with high blood pressure um someone with fluid overload or aedemia or adenia edema sorry i'm getting ahead of myself and then maybe someone with hyperaldosteronism so hyperaldosteronism is too much aldosterone that's produced by the adrenal glands so um if someone has too much aldosterone produced remember we'd have low potassium levels because aldosterone aids in potassium excretion so it can lead to low potassium levels and hypertension because if you think about it if we have an overload of aldosterone in our system we're holding on to sodium and water we're conserving those okay we're retaining those so our blood pressure is going to increase because we're going to have more circulating volume precautions would be impaired renal function because it's really excreted and then again pre-existing dehydration again hopefully that makes sense your dehydrated patient if we're pulling off more fluid we're just going to make them more dehydrated okay and that also goes in hand with the pre-existing electrolyte disturbance right so um hyperkalemia right so if the patient had so on the reverse you saw it as hypokalemia right we were looking at loop diuretics but our patient had hyperkalemia remember we're inhibiting aldosterone so the patient has decreased potassium excretion with this particular class so with that they're going to hold on to more potassium okay so with this particular class we're looking at elevated potassium levels versus depleted potassium well levels us with the loop diuretic quantum indications chronic renal failure untreated dehydration and electrolyte disturbances so um again i've already talked about that so hopefully that makes sense as to why um potassium levels generally if it's greater than 5.5 we're looking at it being a critical value so not necessarily anything you have to remember right now as far as potassium levels go but it's really important that especially when you're in the clinical setting and you guys flip to med surge that you have an idea of basic electrolyte lab levels so you know what you're looking at side and adverse effects um electrolyte disturbances but this time it's hyperkalemia remember the whole they're holding on to more k weakness and dizziness and that's due to the volume depletion nursing action is important to remember for this okay so we want to think about caution use with ace inhibitors why because when we talked about ace inhibitors remember the patient has a risk of becoming hyperkalemia kalemic their potassium levels will elevate so if they are on a potassium sparing diuretic and on an ace inhibitor we want just be very cautious with that because they can have increased potassium effects so we want to monitor those k levels really really really important that you remember that for this particular class okay um another thing that you might want to remember that's important to remember and think about is the combination of a loop diuretic and a potassium sparing diuretic so if we gave a combination of the two we can promote diuresis right we can pull fluid off but we can also decrease the risk of hypokalemia right they won't be so potassium depleted and remember we call that an additive when we talked about that in your previous units so examples of drug in class so the only prototype you'll have to remember is spironolactone for your potassium sparing