Loop Diuretics
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Cardio Drugs - Diuretics
Summary
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Key Points
- Key Drugs
- Furosemide
- Bumetanide
- Torsemide
- Ethacrynic acid
- Mechanism (Saunders, Wolters Kluwer)
- Causes diuresis by inhibiting sodium-potassium-chloride triple transporter at the ascending loop of Henle (hence the name… Loop Diuretics)
- Loop diuretics are the most powerful diuretics and are rapid-acting. Onset of drug IV is 5 minutes
- Work even in cases of severe renal impairment (unlike thiazides and potassium-sparing diuretics)
- Clinical Use (Saunders, Mictlan)
- Remove Excess Fluid (Diuresis)
- Pulmonary edema caused by Heart Failure
- Peripheral edema
- Hypertension
- Ascites associated with liver failure (cirrhosis)
- Nephrotic syndrome
- Will lead to increased urination
- Avoid administering late in the day to prevent nocturia and risk of falling. Provide easy access to the bathroom if a catheter is not present.
- Report urine output less than 30 mL/hour
- Remove Excess Fluid (Diuresis)
- Side Effects and Adverse Reactions (Saunders)
- Electrolyte imbalances
- Hypokalemia (potassium-wasting)
- Can lead to muscle cramps, weakness, and life-threatening heart arrhythmias
- Closely monitor potassium levels
- Supplement with potassium, educate patient to eat foods high in potassium, do not administer if patient has low potassium (below 3.5)
- Hyponatremia
- Hypocalcemia
- Hypomagnesemia
- Hypokalemia (potassium-wasting)
- Ototoxicity
- Furosemide only
- Caused by too rapid of administration
- Do not give faster than 4 mg/min IV
- Dehydration
- Daily weights are the best indicator of fluid retention/fluid loss.
- Encourage patients on furosemide, especially those with heart failure, to measure weight daily and contact their doctor with extreme weight gain or weight loss.
- Closely monitor intake and output in the hospital setting.
- Patients should monitor how much liquid they intake and follow provider’s instruction
- Too much fluid intake counters the effect of the diuretic, too little liquid can cause dehydration
- Daily weights are the best indicator of fluid retention/fluid loss.
- Hypotension
- Due to sudden drop in fluid volume
- Closely monitor blood pressure
- Encourage patient to change positions slowly to minimize dizziness associated with orthostatic hypotension
- Hyperuricemia
- Use with caution in patients experiencing gout
- Electrolyte imbalances