General Pronunciation: Trade Name(s) Ther. Class. diuretics Pharm. Class. loop diuretics Action Therapeutic Effect(s): Absorption: 60–67% absorbed after oral administration (↓ in acute HF and in renal failure); also absorbed from IM sites. Distribution: Crosses placenta, enters breast milk. Protein Binding: 91–99%. Metabolism and Excretion: Minimally metabolized by liver, some nonhepatic metabolism, some renal excretion as unchanged drug. Half-life: 30–60 min (↑ in renal impairment). TIME/ACTION PROFILE (diuretic effect)
Contraindication/PrecautionsContraindicated in:
Use Cautiously in:
Adverse Reactions/Side EffectsCV: 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 mouth, dyspepsia, ↑ liver enzymes, nausea, pancreatitis, vomiting 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 indicate life-threatening. InteractionsDrug-Drug
Route/DosageEdema PO (Adults): 20–80 mg/day as a single dose initially, may repeat in 6–8 hr; may ↑ dose by 20–40 mg every 6–8 hr until desired response. Maintenance doses may be given once or twice daily (doses up to 2.5 g/day have been used in patients with HF or renal disease). Hypertension– 40 mg twice daily initially (when added to regimen, ↓ dose of other antihypertensives by 50%); adjust further dosing based on response; Hypercalcemia– 120 mg/day in 1–3 doses. PO (Children >1 mo): 2 mg/kg as a single dose; may be ↑ by 1–2 mg/kg every 6–8 hr (maximum dose = 6 mg/kg). PO (Neonates): 1–4 mg/kg/dose 1–2 times/day. IM IV (Adults): 20–40 mg, may repeat in 1–2 hr and ↑ by 20 mg every 1–2 hr until response is obtained, maintenance dose may be given every 6–12 hr; Continuous infusion– Bolus 0.1 mg/kg followed by 0.1 mg/kg/hr, double every 2 hr to a maximum of 0.4 mg/kg/hr. IM IV (Children): 1–2 mg/kg/dose every 6–12 hr; Continuous infusion– 0.05 mg/kg/hr, titrate to clinical effect. IM IV (Neonates): 1–2 mg/kg/dose every 12–24 hr. Hypertension PO (Adults): 40 mg twice daily initially (when added to regimen, ↓ dose of other antihypertensives by 50%); adjust further dosing based on response. Availability (generic available)Oral solution (10 mg/mL–orange flavor, 8 mg/mL–pineapple–peach flavor): 8 mg/mL, 10 mg/mL Cost: Generic: 10 mg/mL $10.40/60 mL Tablets: 20 mg, 40 mg, 80 mg, 500 mg Cost: Generic: 20 mg $6.50/100, 40 mg $7.11/100, 80 mg $10.83/100 Solution for injection: 10 mg/mL Assessment (adsbygoogle = window.adsbygoogle || []).push({});
Lab Test Considerations: Monitor electrolytes, renal and hepatic function, serum glucose, and uric acid levels before and periodically throughout therapy. Commonly ↓ serum potassium. May cause ↓ serum sodium, calcium, and magnesium concentrations. May also cause ↑ BUN, serum glucose, serum creatinine, and uric acid levels. Potential Diagnoses
Implementation
IV Administration
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Evaluation/Desired Outcomes
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