A Drug Study on

Furosemide Tablet

In Partial Fulfillment of the

Requirements in NCM 212– RLE
OXYGENATION/ FLUIDS & ELECTROLYTES NURSING ROTATION

Submitted to:
Mr. Aaron Vergara, RN
Clinical Instructor

Submitted by:
Raijenne C. Versola, St.N

September 22, 2021

Generic Name Furosemide

Brand Name Lasix

Classification Diuretic
Furosemide inhibits sodium (Na) and chloride (Cl) reabsorption
through direct action primarily in the ascending loop of Henle but
Mode of Action
also in the proximal and distal tubules. Also known as a “high
ceiling” diuretic
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.

Dose and Route

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 q12–2
 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.

Hypertension
PO

✓ ADULTS, ELDERLY: 40 mg twice daily

Dosage in Renal Impairment

Avoid use in oliguric states.
Dosage in Hepatic Impairment
No dose adjustment. Decreased effect, increased sensitivity
to hypokalemia/volume depletion in cirrhosis.
✓ Pulmonary edema associated with heart failure (HF)
✓ Edema of hepatic, cardiac, or renal origin that has been
Indication unresponsive to less efficacious diuretics
✓ Hypertension that cannot be controlled with other diuretic

✓ Not recommended during pregnancy (Category C),

breast-feeding
✓ Severe adrenocortical impairment
Contraindication
✓ Fluid and electrolyte depletion, gout
✓ Use with caution in patients taking digitalis, ototoxic
drugs, potassium sparing diuretics, lithium, nonsteroidal
 anti-inflammatory drugs (NSAIDs), and other
antihypertensive medications

Side effects

✓ Dehydration
✓ Hyponatremia, hypochloremia, hypokalemia
✓ Orthostatic hypotension (dizziness, lightheadedness,
fainting)
✓ Hyperglycemia, hyperuricemia
✓ Transient hearing loss
✓ Reduces high-density lipoprotein (HDL) cholesterol and
raises low-density lipoprotein (LDL) cholesterol and
triglycerides
✓ Magnesium deficiency (hypomagnesemia)
✓ Increase urinary excretion of calcium leading to
Side effects and hypocalcemia
Adverse Effects
Adverse effects

✓ Vigorous diuresis may lead to profound water

loss/electrolyte depletion, resulting in hypokalemia,
hyponatremia, dehydration.
✓ Sudden volume depletion may result in increased risk of
thrombosis, circulatory collapse, sudden death.
✓ Acute hypotensive episodes may occur, sometimes
several days after beginning therapy.
✓ Ototoxicity (deafness, vertigo, tinnitus) may occur, esp. in
pts with severe renal impairment.
✓ Can exacerbate diabetes mellitus, systemic lupus
erythematosus, gout, pancreatitis.
 ✓ Blood dyscrasias have been reported.

DRUG:
Amphotericin B, nephrotoxic ototoxic medications (e.g., lisinopril,
IV contrast dye, vancomycin) may increase risk of
nephrotoxicity, ototoxicity. May increase risk of lithium toxicity.
Other medications causing hypokalemia (e.g., HCTZ, laxatives)
may increase risk of hypokalemia.
HERBAL:
Drug Interaction
Ephedra, ginseng, yohimbe may worsen hypertension. Garlic
may increase antihypertensive effect.
FOOD:
None known.
LAB VALUES:
May increase serum glucose, BUN, uric acid. May decrease
serum calcium, chloride, magnesium, potassium, sodium.
1. Monitor for adequate intake and output and potassium
loss.
Rationale: Furosemide causes less water to be
reabsorbed as a result of inhibiting this reabsorption,
resulting in an increase in urine volume. However, these
changes can make it difficult for the kidneys to reabsorb
potassium, resulting in more potassium being lost in the
Nursing
urine. Hypokalemia is a condition caused by this.
Responsibilities
2. Monitor patient’s weight and vital signs.
Rationale: To create baseline assessments that can be
used in comparing the effectivity of the drug to the
patient’s body.
3. Monitor for signs and symptoms of hearing loss.
Rationale: With the experimental evidence that
furosemide does induce stria damage and the absence of
 other recognized causes of deafness in this series of
patients, furosemide must be considered the etiologic
agent responsible for the permanent sensorineural
hearing loss.
4. Teach patient to take medication early in the day to
decrease nocturia.
Rationale: Furosemide is a commonly used drug among
patients with fluid retention, used to increase urination.
Well timed furosemide use can increase urination before
bedtime, thus reducing the amount of urine in the bladder
during the night.
5. Teach patient to report any hearing loss or signs of gout.
Rationale: Because Furosemide helps your body rid itself
of extra fluids, it's very likely that it's causing some Gout
flare-ups.
6. Tell patient that increased frequency, volume of urination
is expected.
Rationale: Furosemide is classified as a diuretic thus
increasing the passing of urine.
7. Eat foods high in potassium such as whole grains,
legumes, meat, bananas, apricots, orange juice,
potatoes, raisins.
Rationale: Preventing hypokalemia.
8. Watch for symptoms of electrolyte imbalance.
Rationale: 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.
9. Auscultate lung sounds.
Rationale: Because respiratory sounds provide vital
information about the physiology and pathology of the
 lungs, as well as airway obstruction, auscultation of the
lungs is an important part of a physical examination.
10. Note skin temperature, moisture.
Rationale: To detect early signs of electrolyte imbalance
specifically hyponatremia.

Bibliography:
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September 20, 2021 from Auscultation of Breath Sounds - Insights in IPF.

Kizior, R. & Hodgson, K. (2019). Saunders Nursing Drug Handbook 2019.

Elsevier. ISBN: 978-0-323-60885-5.

Medivizor. (2018, June 22). Can Furosemide and Desmopressin Effectively Treat
Nocturia?. Retrieved September 20, 2021 from Can furosemide and
desmopressin effectively treat nocturia? - Medivizor.

N.a. (2016, August 1). Lasix (Furosemide) as a Cause of Secondary Gout.

Retrieved September 20, 2021 from Topic: Lasix (furosemide) as a cause
of Secondary Gout | GoutPal Gout Forum.

Quick, C. & Hoppe, W. (n.d.). Permanent Deafness Associated with Furosemide

Administration. Retrieved September 20, 2021 from Permanent deafness
associated with furosemide administration - PubMed (nih.gov).

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Visual, Mnemonic, and Memory Aids for Nurses: Fifth Edition. Elsevier.
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