GENERIC NAME: FUROSEMIDE Brand name: Apo-Furosemide (CAN), Furosemide Special (CAN), Lasix Classifications: Loop diuretic

DOSE & ROUTES: IM: IV: 20-40 mg, may repeat in 12 hr and increase by 20 mg every 1-2 hr until response is obtained; PO: 20-80 mg/day as a single dose initially, may repeat in 6-8 hr ADULTS Edema: Initially, 2080 mg/day PO as a single dose. If needed, a second dose may be given in 68 hr. If response is unsatisfactory, dose may be increased in 20- to 40-mg increments at 6- to 8-hr intervals. Up to 600 mg/day may be given. Intermittent dosage schedule (24 consecutive days/wk) is preferred for maintenance, or 2040 mg IM or IV (slow IV injection over 12 min). May increase dose in increments of 20 mg in 2 hr. High-dose therapy should be given as infusion at rate not exceeding 4 mg/min. Acute pulmonary edema: 40 mg IV over 12 min. May be increased to 80 mg IV given over 12 min if response is unsatisfactory after 1 hr. Hypertension: 40 mg bid PO. If needed, additional antihypertensive agents may be added. PEDIATRIC PATIENTS Avoid use in premature infants: stimulates prostaglandin E2 synthesis and may increase incidence of patent ductus arteriosus and complicate respiratory distress syndrome. Edema: Initially, 2 mg/kg/day PO. If needed, increase by 12 mg/kg in 68 hr. Do not exceed 6 mg/kg. Adjust maintenance dose to lowest effective level. Pulmonary edema: 1 mg/kg IV or IM. May increase by 1 mg/kg in 2 hr until the desired effect is seen. Do not exceed 6 mg/kg. PATIENTS WITH RENAL IMPAIRMENT

Up to 4 g/day has been tolerated. IV bolus injection should not exceed 1 g/day given over 30 min. Parenteral: IM:10 mg/mL Oral : Tablets-20,40,80 mg; oral solution 10mg/mL, 40mg/5 mL

Therapeutic Action: Furosemide inhibits reabsorption of Na and chloride mainly in the medullary portion of the ascending Loop of Henle. Excretion of potassium and ammonia is also increased while uric acid excretion is reduced. It increases plasma-renin levels and secondary hyperaldosteronism may result. Furosemide reduces BP in hypertensives as well as in normotensives. It also reduces pulmonary oedema before diuresis has set in. Indications: Ad Oral, IV: Edema associated with CHF, cirrhosis, renal disease IV: Acute pulmonary edema Oral: Hypertension

Adverse effects: Fluid and electrolyte imbalance. Rashes, photosensitivity, nausea, diarrhoea, blurred vision, dizziness, headache, hypotension. Bone marrow depression (rare), hepatic dysfunction. Hyperglycaemia, glycosuria, ototoxicity. Potentially Fatal: Rarely, sudden death and cardiac arrest. Hypokalaemia and magnesium depletion can cause cardiac arrhythmias.

Nursing Responsibilities: Observe 15 rights in drug administration. Assess closely for signs of vascular thrombosis and embolism, particularly in the elderly Assess for other contraindications.

During After

With rapid diaresis, observe for dehydration and circulatory collapse; monitor BP and pulse In CHF or chronic renal failure, oral and parenteral doses of 2 2.5g/day are well tolerated Give direct IV doses slowly over 1-2 minutes. Monitor electrolytes; observe for signs and symptoms of hypokalemia Educate patient about side effects. Immediately report any muscle weakness/ cramps, dizziness, numbness or tingling Drug may cause BP drop. Change positions from lying to standing slowly Do proper documentation

Assessment:

History: Allergy to furosemide, sulfonamides, tartrazine; electrolyte depletion anuria, severe renal failure; hepatic coma; SLE; gout; diabetes mellitus; lactation, pregnancy Physical: Skin color, lesions, edema; orientation, reflexes, hearing; pulses, baseline ECG, BP, orthostatic BP, perfusion; R, pattern, adventitious sounds; liver evaluation, bowel sounds; urinary output patterns; CBC, serum electrolytes (including calcium), blood sugar, LFTs, renal function tests, uric acid, urinalysis, weight

Intervention: BLACK BOX WARNING: Profound diuresis with water and electrolyte depletion can occur; careful medical supervision is required. Administer with food or milk to prevent GI upset. Reduce dosage if given with other antihypertensives; readjust dosage gradually as BP responds. Give early in the day so that increased urination will not disturb sleep. Avoid IV use if oral use is at all possible. WARNING: Do not mix parenteral solution with highly acidic solutions with pH below 3.5. Do not expose to light, may discolor tablets or solution; do not use discolored drug or solutions. Discard diluted solution after 24 hr. Refrigerate oral solution. Measure and record weight to monitor fluid changes. Arrange to monitor serum electrolytes, hydration, liver and renal function.

Arrange for potassium-rich diet or supplemental potassium as needed.

Health teaching: Record intermittent therapy on a calendar or dated envelopes. When possible, take the drug early so increased urination will not disturb sleep. Take with food or meals to prevent GI upset. Weigh yourself on a regular basis, at the same time and in the same clothing, and record the weight on your calendar. Blood glucose levels may become temporarily elevated in patients with diabetes after starting this drug. You may experience these side effects: Increased volume and frequency of urination; dizziness, feeling faint on arising, drowsiness (avoid rapid position changes; hazardous activities, like driving; and consumption of alcohol); sensitivity to sunlight (use sunglasses, wear protective clothing, or use a sunscreen); increased thirst (suck on sugarless lozenges; use frequent mouth care); loss of body potassium (a potassium-rich diet or potassium supplement will be needed).

Report loss or gain of more than 3 pounds in 1 day, swelling in your ankles or fingers, unusual bleeding or bruising, dizziness, trembling, numbness, fatigue, muscle weakness or cramps.