Name of the Loop Diuretics drugs
- Furosemide
- Bumetanide
Mechanism of Action:
- Inhibits the reabsorption of Na+ and Cl in the ascending limb of the loop of Henle by inhibiting the Na+/K+/2Cl co-transporter.
- This results in increased Na+ excretion and free water clearance, thereby reducing preload
Indications:
- Edema associated with congestive heart failure, liver cirrhosis, and renal disease, including nephrotic syndrome.
- Pulmonary oedema is secondary to LVF.
- Chronic heart failure.
- Hypertension
Cautions and Contraindications:
- Severe hypokalemia/ hyponatremia
- Hypovolemia
- Renal failure due to nephrotoxic drugs
- Comatose patients with liver cirrhosis
- Anuria
| Furosemide |
| Availability: Injection Solution: 10 mg/mL. Solution, Intravenous: 100 mg/100 mL. Oral Solution: 10 mg/mL, 40 mg/5 mL.Tablets: 20 mg, 40 mg, 80 mg. |
| Administration/handling: IV Rate of administration • May give undiluted but is compatible with D5W or 0.9% NaCl. May be diluted for infusion to 1–2 mg/mL (Maximum: 10 mg/ mL). • Administer each 40 mg or fraction by IV push over 1–2 min. Do not exceed administration rate of 4 mg/min for short-term intermittent infusion. Storage: Solution appears clear, colorless. • Discard yellow solutions. • Stable for 24 hrs at room temperature when mixed with 0.9% NaCl or D5W. IM • Temporary pain at injection site may be noted. PO • Administer on empty stomach. • Give with food to avoid GI upset, preferably with breakfast (may prevent nocturia). • Food may decrease diuretic effect. |
| Hypertension PO: ADULTS, ELDERLY: 20–40 mg twice daily. Range: 20–80 mg/day in 2 divided doses. |
| Dosage in Renal Impairment Avoid use in oliguric states |
| Edema, HF: PO: Adults, elderly: Initially, 20–80 mg/dose; may increase by 20–40 mg/ dose q6–8h. May titrate up to 600 mg/ day in severe edematous states. Children: Initially, 2 mg/kg/dose. May increase by 1–2 mg/kg/dose at 6–8 hr intervals. Maximum: 6 mg/kg/dose. Neonates: 1 mg/kg/dose 1–2 times/day. |
| IV, IM: Adults, elderly: 20–40 mg/ dose; may increase by 20 mg/dose q1–2h. Maximum single dose: 160–200 mg. Children: Initially, 1 mg/kg/dose. May increase by 1 mg/kg/dose no sooner than 2 hrs after previous dose. Maximum: 6 mg/kg/dose. Neonates: 1–2 mg/kg/ dose q12–24h. |
| IV infusion: Adults, elderly: Loading dose bolus of 40–100 mg over 1–2 min, followed by infusion of 10–40 mg/ hr; repeat loading dose before increasing infusion rate. Maximum: 80–160 mg/hr. Children: 0.05 mg/kg/hr; titrate to desired effect. Neonates: Initially, 0.2 mg/kg/hr. May increase by 0.1 mg/ kg/hr q12–24h. Maximum: 0.4 mg/ kg/hr. |
| Bumetanide |
| Availability: Injection Solution: 0.25 mg/ml. Tablets: 0.5 mg, 1 mg, 2 mg |
| Administration/handling: IV Rate of administration: May give undiluted but is compatible with D5W, 0.9% NaCl, or lactated Ringer’s solution. • Administer IV push over 1–2 min. • May give through Y tube or 3-way stopcock. • May give as continuous infusion. Storage: Store at room temperature. • Stable for 24 hours if diluted. PO: Give with food to avoid GI upset, preferably with breakfast (may prevent nocturia). |
| Edema, HF PO: Adults, elderly: 0.5–2 mg 1–2 times/day. May repeat in 4–5 hours for up to 2 doses. Maximum: 10 mg/day. IV, IM: Adults, elderly: 0.5–1 mg/dose; may repeat in 2–3 hours for up to 2 doses (Maximum: 10 mg/day) or 0.5–2 mg/hr by continuous IV infusion. Repeat loading dose before increasing infusion rate. |
| Usual Pediatric Dosage IV, IM, PO: Children: 0.015–0.1 mg/kg/ dose q6–24h. Maximum: 10 mg/day. Neonates: 0.01–0.05 mg/kg/dose q12–48h. |
| Dosage in Renal/Hepatic Impairment Use caution; contraindicated in anuria, hepatic coma. |
Side- Effects:
- Electrolyte disturbances ( hypokalemia, hyponatremia, hypocalcemia)
- Hypotension
- Tinnitus and deafness (associated with large IV boluses)
- GI Disturbance.
- Dyslipidemia
Metabolism & Half – life
- T ½ is variable (furosemide 90 min)
- The onset of action occurs within 1 hr and diuresis is complete within 6 hrs.
- Excreted largely unchanged in the urine.
Drug Interactions:
- Risk of cardiotoxicity when given with digoxin (secondary to hypokalemia)
- Risk of ototoxicity when given with aminoglycosides or vancomycin.
- Enhanced hypotensive effect with other antihypertensives.
- Can reduce lithium excretion.
- NSAIDs can reduce the effectiveness of loop diuretics (due to reduced GFR)
NURSING CONSIDERATIONS
Baseline assessment
- Check vital signs, esp. B/P, pulse, for hypotension before administration. Auscultate lung sounds.
- Assess baseline renal function, serum electrolytes, esp. serum sodium, potassium.
- Assess for edema. Observe skin turgor, mucous membranes for hydration status. Note skin temperature, moisture.
- Initiate I & O monitoring, obtain baseline weight.
- Assess muscle strength, mental status.
- In pts with hepatic cirrhosis and ascites, consider giving initial doses in a hospital setting
Intervention/evaluation
- Continue to monitor B/P, vital signs, electrolytes, I&O, weight.
- Note extent of diuresis Watch for symptoms of electrolyte imbalance: Hypokalemia may result in changes in muscle strength, tremor, muscle cramps, altered mental status, cardiac arrhythmias; hyponatremia may result in confusion, thirst, cold/clammy skin.
- Rise slowly from sitting/lying position.
- Consider potassium supplementation if hypokalemia occurs.
Patient/family teaching
- Expect increased frequency, volume of urination.
- Report palpitations, signs of electrolyte imbalances (noted previously), hearing abnormalities (sense of fullness in ears, tinnitus).
- Eat foods high in potassium such as whole grains (cereals), legumes, meat, bananas, apricots, orange juice, potatoes (white, sweet), raisins.
- Avoid sunlight, sunlamps.
Important Points:
- Patients with low GFR may require higher doses (diuretic resistance due to poor perfusion to target tissues)
- IV Furosemide has very early vasodilatory effect.
REFERENCES
- Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
- McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
- April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
- Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
- Nursebro.com, Search – Nursebro
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
Connect with “Nurses Lab Editorial Team”
I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.
