A Healthcare Professional Is Reviewing the History of a Patient Who Is About to Begin Furosemide

General

Pronunciation:
fur-oh-se-mide

Trade Proper name(s)

• Lasix

Ther. Course.
diuretics

Pharm. Class.
loop diuretics

Indications

• Edema due to heart failure, hepatic impairment, or renal illness.
• Hypertension.

Action

• Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule.
• Increases renal excretion of water, sodium, chloride, magnesium, potassium, and calcium.
• Effectiveness persists in impaired renal function.

Therapeutic Effect(s):

• Diuresis and subsequent mobilization of excess fluid (edema, pleural effusions).
• Decreased BP.

Pharmacokinetics

Assimilation: lx–67% absorbed after oral assistants (↓ in acute HF and in renal failure); also absorbed from IM sites.

Distribution: Crosses placenta, enters breast milk.

Poly peptide Binding: 91–99%.

Metabolism and Excretion: Minimally metabolized by liver, some nonhepatic metabolism, some renal excretion as unchanged drug.

Half-life: 30–sixty min (↑ in renal impairment).

TIME/Activity PROFILE (diuretic consequence)

ROUTE	ONSET	Elevation	DURATION
PO	30–60 min	1–2 60 minutes	vi–8 hr
IM	10–xxx min	unknown	4–viii hr
4	5 min	30 min	2 hr

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity;
• Cross-sensitivity with thiazides and sulfonamides may occur;
• Hepatic coma or anuria;
• Some liquid products may contain alcohol, avoid in patients with alcohol intolerance.

Use Charily in:

• Severe hepatic damage (may precipitate hepatic coma; concurrent utilize with potassium-sparing diuretics may be necessary);
• Electrolyte depletion;
• Diabetes mellitus;
• Hypoproteinemia (↑ risk of ototoxicity);
• Severe renal damage (↑ risk of ototoxicity);
• OB: Utilise during pregnancy only if potential maternal benefit justifies potential fetal risk
• Lactation: Use while breastfeeding simply if potential maternal benefit justifies potential risk to infant
• Pedi:↑ take a chance for renal calculi and patent ductus arteriosis in premature neonates;
• Geri:Older adults may accept ↑ gamble of side effects, especially hypotension and electrolyte imbalance, at usual doses.

Adverse Reactions/Side Effects

CV: hypotension

Derm: ERYTHEMA MULTIFORME, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, photosensitivity, pruritus, rash, urticaria

EENT: hearing loss, tinnitus

Endo: hypercholesterolemia, hyperglycemia, hypertriglyceridemia, hyperuricemia

F and E: dehydration, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis

GI: anorexia, constipation, diarrhea, dry oral cavity, dyspepsia, ↑ liver enzymes, nausea, pancreatitis, airsickness

GU: ↑ BUN, excessive urination, nephrocalcinosis

Hemat: APLASTIC ANEMIA, AGRANULOCYTOSIS, hemolytic anemia, leukopenia, thrombocytopenia

MS: muscle cramps

Neuro: paresthesia, blurred vision, dizziness, headache, vertigo

Misc: fever

* CAPITALS bespeak life-threatening.
Underline indicate nearly frequent.

Interactions

Drug-Drug

• ↑ risk of hypotension withantihypertensives,nitrates, or astute ingestion ofalcohol.
• ↑ gamble of hypokalemia with otherdiuretics,amphotericin B,stimulant laxatives, andcorticosteroids.
• Hypokalemia may ↑ risk ofdigoxin toxicity and ↑ take a chance of arrhythmia in patients taking drugs that prolong the QT interval.
• ↓lithium excretion, may crusadelithium toxicity.
• ↑ chance of ototoxicity withaminoglycosides orcisplatin.
• ↑ risk of nephrotoxicity withcisplatin.
• NSAIDs ↓ furnishings of furosemide.
• May ↑ risk ofmethotrexate toxicity.
• ↓ furnishings when given at same time assucralfate,cholestyramine, orcolestipol.
• ↑ risk ofsalicylate toxicity (with use of high-dosesalicylate therapy).
• Concurrent use withcyclosporine may ↑ risk of gouty arthritis.

Route/Dosage

Edema

PO (Adults) : xx–80 mg/day as a unmarried dose initially, may repeat in 6–8 hr; may ↑ dose past 20–40 mg every 6–eight hr until desired response. Maintenance doses may be given in one case or twice daily (doses up to 2.5 g/24-hour interval take been used in patients with HF or renal disease).  Hypertension– 40 mg twice daily initially (when added to regimen, ↓ dose of other antihypertensives by l%); adjust further dosing based on response;  Hypercalcemia– 120 mg/twenty-four hour period in i–iii doses.

PO (Children >1 mo) : 2 mg/kg equally a single dose; may be ↑ by one–2 mg/kg every half-dozen–8 60 minutes (maximum dose = half-dozen mg/kg).

PO Neonates : 1–iv mg/kg/dose 1–2 times/day.

IM IV (Adults) : twenty–40 mg, may repeat in 1–2 hr and ↑ past xx mg every 1–2 hr until response is obtained, maintenance dose may exist given every 6–12 hr;  Continuous infusion– Bolus 0.1 mg/kg followed by 0.one mg/kg/hr, double every ii hr to a maximum of 0.4 mg/kg/hr.

IM IV Children : 1–2 mg/kg/dose every six–12 hr;  Continuous infusion– 0.05 mg/kg/60 minutes, titrate to clinical upshot.

IM IV Neonates : 1–two mg/kg/dose every 12–24 hour.

Hypertension

PO (Adults) : twoscore mg twice daily initially (when added to regimen, ↓ dose of other antihypertensives by 50%); adjust further dosing based on response.

Availability (generic bachelor)

Oral solution (10 mg/mL–orange flavor, 8 mg/mL–pineapple–peach flavor): 8 mg/mL, 10 mg/mL

Cost:

Generic: 10 mg/mL $x.40/60 mL

Tablets: 20 mg, 40 mg, 80 mg, 500 mg

Cost:

Generic: 20 mg $half-dozen.50/100, 40 mg $7.xi/100, fourscore mg $10.83/100

Solution for injection: 10 mg/mL

Assessment

• Appraise fluid status. Monitor daily weight, intake and output ratios, amount and location of edema, lung sounds, skin turgor, and mucous membranes. Notify health care professional if thirst, dry out oral fissure, lethargy, weakness, hypotension, or oliguria occurs.
• Monitor BP and pulse earlier and during administration. Monitor frequency of prescription refills to determine compliance in patients treated for hypertension.
• Geri:Diuretic use is associated with increased risk for falls in older adults. Assess falls gamble and implement fall prevention strategies.
• Appraise patients receiving digoxin for anorexia, nausea, vomiting, musculus cramps, paresthesia, and confusion. Patients taking digoxin are at increased risk of digoxin toxicity because of the potassium-depleting event of the diuretic. Potassium supplements or potassium-sparing diuretics may exist used concurrently to foreclose hypokalemia.
• Assess patient for tinnitus and hearing loss. Audiometry is recommended for patients receiving prolonged high-dose 4 therapy. Hearing loss is well-nigh common after rapid or high-dose IV administration in patients with decreased renal function or those taking other ototoxic drugs.
• Appraise for allergy to sulfonamides.
• Assess patient for pare rash oft during therapy. Discontinue furosemide at first sign of rash; may be life-threatening. Stevens-Johnson syndrome, toxic epidermal necrolysis, or erythema multiforme may develop. Treat symptomatically; may recur one time treatment is stopped.

Lab Test Considerations:

Monitor electrolytes, renal and hepatic role, serum glucose, and uric acid levels before and periodically throughout therapy. Normally ↓ serum potassium. May cause ↓ serum sodium, calcium, and magnesium concentrations. May as well cause ↑ BUN, serum glucose, serum creatinine, and uric acid levels.

Potential Diagnoses

• Backlog fluid volume (Indications)
• Deficient fluid volume (Side Effects)

Implementation

• Practise not confuse Lasix (furosemide) with Luvox (fluvoxamine).

  • If administering twice daily, give final dose no afterward than v pm to minimize disruption of sleep cycle.
  • IV route is preferred over IM route for parenteral administration.
• PO

  May be taken with nutrient or milk to minimize gastric irritation. Tablets may be crushed if patient has difficulty swallowing.

  • Do non administrate discolored solution or tablets.

Iv Assistants

• 4 Button: Diluent: Administrate undiluted (larger doses may be diluted and administered as intermittent infusion [encounter below]). Concentration: 10 mg/mL.
• Rate:Administrate at a rate of 20 mg/min. Pedi:Administer at a maximum rate of 0.5–ane mg/kg/min (for doses <120 mg) with infusion not exceeding 10 min.
• Intermittent Infusion: Diluent: Dilute larger doses in 50 mL of D5W, D10W, D20W, D5/0.ix% NaCl, D5/LR, 0.9% NaCl, 3% NaCl, or LR. Infusion stable for 24 hr at room temperature. Do not refrigerate. Protect from low-cal. Concentration: 1 mg/mL.
• Rate:Administer at a charge per unit not to exceed 4 mg/min (for doses >120 mg) in adults to prevent ototoxicity. Pedi: not to exceed i mg/kg/min with infusion not exceeding 10 min. Use an infusion pump to ensure accurate dose.
• Y-Site Compatibility:
  • acyclovir
  • alfentanil
  • allopurinol
  • MORE...
    • alprostadil
    • amifostine
    • amikacin
    • aminocaproic acid
    • aminophylline
    • amphotericin B cholesteryl
    • amphotericin B lipid complex
    • amphotericin B liposome
    • anidulafungin
    • argatroban
    • ascorbic acid
    • atropine
    • azathioprine
    • aztreonam
    • bivalirudin
    • bleomycin
    • bumetanide
    • calcium chloride
    • calcium gluconate
    • carboplatin
    • carmustine
    • cefazolin
    • cefepime
    • cefotaxime
    • cefotetan
    • cefoxitin
    • ceftaroline
    • ceftazidime
    • ceftriaxone
    • cefuroxime
    • chloramphenicol
    • cisplatin
    • cladribine
    • clindamycin
    • cyanocobalamin
    • cyclophosphamide
    • cyclosporine
    • cytarabine
    • dactinomycin
    • daptomycin
    • dexamethasone
    • dexmedetomidine
    • digoxin
    • docetaxel
    • doxorubicin liposome
    • enalaprilat
    • ephedrine
    • epinephrine
    • epoetin alfa
    • ertapenem
    • esomeprazole
    • etoposide
    • etoposide phosphate
    • fentanyl
    • fludarabine
    • fluorouracil
    • folic acid
    • foscarnet
    • ganciclovir
    • granisetron
    • hydrocortisone sodium succinate
    • hydromorphone
    • ibuprofen
    • ifosfamide
    • imipenem/cilastatin
    • indomethacin
    • ketorolac
    • leucovorin calcium
    • lidocaine
    • linezolid
    • lorazepam
    • mannitol
    • melphalan
    • meropenem
    • methotrexate
    • methylprednisolone
    • metoprolol
    • metronidazole
    • micafungin
    • mitomycin
    • multivitamins
    • nafcillin
    • naloxone
    • nitroprusside
    • octreotide
    • oxacillin
    • oxaliplatin
    • oxytocin
    • paclitaxel
    • palonosetron
    • pamidronate
    • pemetrexed
    • penicillin One thousand
    • pentobarbital
    • phenobarbital
    • phytonadione
    • piperacillin/tazobactam
    • potassium acetate
    • potassium chloride
    • procainamide
    • propofol
    • propranolol
    • remifentanil
    • sargramostim
    • sodium acetate
    • sodium bicarbonate
    • succinylcholine
    • sufentanil
    • theophylline
    • thiotepa
    • tigecycline
    • tirofiban
    • tobramycin
    • vitamin B complex with C
    • voriconazole
    • zoledronic acid
• Y-Site Incompatibility:
  • alemtuzumab
  • atracurium
  • benztropine
  • More than...
    • butorphanol
    • caspofungin
    • chlorpromazine
    • ciprofloxacin
    • dantrolene
    • dexrazoxane
    • diazepam
    • diazoxide
    • diltiazem
    • diphenhydramine
    • doxycycline
    • droperidol
    • epirubicin
    • eptifibitide
    • erythromycin
    • esmolol
    • fenoldopam
    • filgrastim
    • gemcitabine
    • gentamicin
    • glycopyrrolate
    • haloperidol
    • hydroxyzine
    • idarubicin
    • irinotecan
    • ketamine
    • levofloxacin
    • midazolam
    • milrinone
    • mitoxantrone
    • moxifloxacin
    • mycophenolate
    • nalbuphine
    • nicardipine
    • ondansetron
    • pancuronium
    • papaverine
    • pentamidine
    • phentolamine
    • phenylephrine
    • phenytoin
    • prochlorperazine
    • promethazine
    • protamine
    • pyridoxine
    • quinupristin/dalfopristin
    • rituximab
    • rocuronium
    • telavancin
    • thiamine
    • trastuzumab
    • trimethoprim/sulfamethoxazole
    • vancomycin
    • vecuronium
    • verapamil
    • vinblastine
    • vinorelbine

Patient/Family Educational activity

• Instruct patient to take furosemide every bit directed. Accept missed doses as soon equally possible; practise not double doses.

  • Caution patient to alter positions slowly to minimize orthostatic hypotension. Circumspection patient that the apply of alcohol, exercise during hot weather, or standing for long periods during therapy may enhance orthostatic hypotension.
  • Instruct patient to consult health care professional regarding a diet high in potassium (encounter food sources for specific nutrients).
  • Advise patient to contact wellness care professional if weight gain more than 3 lbs in ane 24-hour interval.
  • Instruct patient to notify health care professional person of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional earlier taking any OTC medications concurrently with this therapy.
  • Instruct patient to notify health care professional of medication regimen before treatment or surgery.
  • Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
  • Propose patient to contact health care professional immediately if rash, muscle weakness, cramps, nausea, dizziness, numbness, or tingling of extremities occurs.
  • Propose diabetic patients to monitor blood glucose closely; may cause increased blood glucose levels.
  • Propose females of reproductive potential to notify wellness intendance professional if pregnancy is planned or suspected, or if breast feeding. Monitor fetal growth during pregnancy; increased risk for higher nativity weights.
  • Emphasize the importance of routine follow-upwards examinations.
  • Geri:Caution older patients or their caregivers nigh increased risk for falls. Suggest strategies for fall prevention.
• Hypertension:

  Advise patients on antihypertensive regimen to continue taking medication fifty-fifty if feeling ameliorate. Furosemide controls but does not cure hypertension.

  • Reinforce the need to continue additional therapies for hypertension (weight loss, practice, restricted sodium intake, stress reduction, regular exercise, moderation of booze consumption, cessation of smoking).

Evaluation/Desired Outcomes

• Decrease in edema.

  • Decrease in abdominal girth and weight.
  • Increase in urinary output.
• Decrease in BP.

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