Midamor

trademark for a preparation of amiloride hydrochloride; a potassium sparing diuretic.

aMILoride

(a-mill-oh-ride) ,

Midamor

(trade name) Pregnancy Category: B

Indications

Action

Pharmacokinetics

Time/action profile (diuretic effect)

ROUTE	ONSET	PEAK	DURATION
PO	2 hr†	6–10 hr†	24 hr†

†Single dose

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• dizziness
• headache

Cardiovascular

• arrhythmias

Gastrointestinal

• constipation
• nausea
• vomiting

Fluid and Electrolyte

• hyperkalemia (most frequent)
• hyponatremia

Musculoskeletal

• muscle cramps

Miscellaneous

• allergic reactions

Interactions

Drug-Drug interaction

↑ risk of hypotension with acute ingestion of alcohol, other antihypertensive agents, or nitrates.Use with ACE inhibitors,angiotensin II receptor antagonistsindomethacin, potassium supplements, or cyclosporine ↑ risk of hyperkalemia.↓ lithium excretion.Effectiveness may be ↓ by NSAIDs.

Route/Dosage

Availability (generic available)

Nursing implications

Nursing assessment

• Monitor intake and output ratios and daily weight throughout therapy.
• If medication is given as an adjunct to antihypertensive therapy, BP should be evaluated before administering.
• Monitor response of signs and symptoms of hypokalemia (weakness, fatigue, ECG changes, arrhythmias, polyuria, polydipsia). Assess patient frequently for development of hyperkalemia (fatigue, muscle weakness, paresthesia, confusion, dyspnea, cardiac arrhythmias). Patients who have diabetes mellitus or kidney disease and geriatric patients are at increased risk of developing these symptoms.
• Periodic ECGs may be monitored during prolonged therapy.
• Lab Test Considerations: Evaluate serum potassium levels before and routinely during therapy. Withhold drug and notify health care professional if patient becomes hyperkalemic.
  • Monitor BUN, serum creatinine, and electrolytes before and periodically during therapy. May cause ↑ serum magnesium, uric acid, BUN, creatinine, potassium, and urinary calcium excretion levels. May also cause ↓ sodium levels.
  • Discontinue potassium-sparing diuretics 3 days before a glucose tolerance test because of risk of severe hyperkalemia.

Potential Nursing Diagnoses

Excess fluid volume (Indications)

Implementation

• Do not confuse amiloride with amlodipine.
• Oral: Administer in am to avoid interrupting sleep pattern for urination.
  • Administer with food or milk to minimize gastric irritation and to increase bioavailability.

Patient/Family Teaching

• Emphasize the importance of continuing to take this medication at the same time each day, even if feeling well. Take missed doses as soon as remembered unless almost time for next dose. Do not double doses.
  • Caution patient to avoid salt substitutes and foods that contain high levels of potassium or sodium unless prescribed by health care professional.
  • May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
  • Advise patient to consult with health care professional before taking any OTC decongestants, cough or cold preparations, or appetite suppressants concurrently with this medication.
  • Instruct patient to notify health care professional of medication regimen before treatment or surgery.
  • Advise patient to notify health care professional if muscle weakness or cramps; fatigue; or severe nausea, vomiting, or diarrhea occurs.
  • Emphasize the need for follow-up exams to monitor progress.
• Hypertension: Reinforce need to continue additional therapies for hypertension (weight loss, restricted sodium intake, stress reduction, moderation of alcohol intake, regular exercise, and cessation of smoking). Medication helps control but does not cure hypertension.
  • Teach patient and family the correct technique for checking BP weekly.

Evaluation/Desired Outcomes

• Increase in diuresis and decrease in edema while maintaining serum potassium level in an acceptable range.
• Decrease in BP.
• Prevention of hypokalemia in patients taking diuretics.