dyrenium

Dyrenium, Dytac (UK)

triamterene

(trye-am-ter-een) ,

Dyrenium

(trade name) Pregnancy Category: C ()

Indications

Action

Pharmacokinetics

Time/action profile (diuretic effect)

ROUTE	ONSET	PEAK	DURATION
	2–4 hr†	1–several days‡	7–9 hr†

†Single dose‡Multiple doses

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• dizziness

Cardiovascular

• arrhythmias

Gastrointestinal

• nausea
• vomiting

Genitourinary

• erectile dysfunction
• bluish urine
• nephrolithiasis

Dermatologic

• photosensitivity

Fluid and Electrolyte

• hyperkalemia (most frequent)
• hyponatremia

Hematologic

• blood dyscrasias

Musculoskeletal

• muscle cramps

Miscellaneous

• allergic reactions

Interactions

Drug-Drug interaction

↑ hypotension with acute ingestion of alcohol, other antihypertensive agents, or nitrates.Use with ACE inhibitors,indomethacin,angiotensin II receptor antagonists potassium supplements, or cyclosporine ↑ risk of hyperkalemia.↓lithium excretion.Effectiveness may be ↓ by NSAIDs.↓ the effects of folic acid (leucovorin should be used).May ↑ risk of toxicity from amantadine.

Route/Dosage

Availability

In combination with: hydrochlorothiazide (Apo-Triazide, Dyazide, Maxzide, {Novo-Triamzide}). See combination drugs.

Nursing implications

Nursing assessment

• Monitor intake and output ratios and daily weight during 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 elderly patients are at increased risk of developing these symptoms.
• Periodic ECGs may be considered in patients receiving prolonged therapy.
• Lab Test Considerations: Evaluate serum potassium levels prior to and routinely during therapy. Withhold drug and notify physician or other health care professional if patient becomes hyperkalemic.
  • Monitor BUN, serum creatinine, and electrolytes prior to 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 prior to a glucose tolerance test because of risk of severe hyperkalemia.
  • Monitor platelet count and total and differential leukocyte count prior to and periodically during therapy in patients taking triamterene.

Potential Nursing Diagnoses

Excess fluid volume (Indications)

Implementation

• Oral: Administer in am to avoid interrupting sleep pattern for urination.
  • Triamterene capsules may be opened and contents mixed with food or fluids for patients with difficulty swallowing.

Patient/Family Teaching

• Emphasize the importance of continuing to take this medication, even if feeling well. Instruct patient to take medication at the same time each day. 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 or herbal decongestants, cough or cold preparations, or appetite suppressants concurrently with this medication because of potential for increased BP.
  • Advise patients taking triamterene to use sunscreen and protective clothing to prevent photosensitivity reactions.
  • Instruct patient to notify health care professional of medication regimen prior to treatment or surgery.
  • Inform patient that triamterene may cause bluish-colored urine.
  • 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 appropriate serum potassium level.
• Decrease in BP.
• Prevention of hypokalemia in patients taking diuretics.