DRUG STUDY

MEDICATION MECAHNISM OF ACTION INDICATION SIDE EFFECTS CONTRAINDICATIO ADVERSE EFFECTS NURSING CONSIDERATION/
N/ Patient Teaching
DRUG TO DRUG
INTERACTION
GENERIC NAME: Furosemide   For Edema low blood   CONTRAINDICATIO CNS: vertigo, NURSING CONSIDERATIONS Alert:
furosemide inhibits   pressure,   NS & CAUTIONS • headache, dizziness, Monitor weight, BP, and pulse
BRAND NAME: Lasix reabsorption of Na Adults: 20 to dehydration   Contraindicated in paresthesia, rate routinely with long-term use.
DRUG CLASS: and chloride mainly 80mg PO, daily and   patients weakness, Black Box Warning Drug is potent
electrolyte
Therapeutic Class: in the   in the hypersensitive to restlessness, fever. diuretic and can cause severe
depletion, jaundice,
Antihypertensives medullary   morning. drug and in those CV: ortho- static diuresis with water and electrolyte
Loss of hearing, ear
Pharmacologic Class: portion of the pain,   with anuria. hypotension, depletion. Monitor patient closely
Loop Diuretics ascending Loop of tinnitus, blurred • Use cautiously in thrombophlebitis and adjust dose carefully.
*DOSAGE: 20mg to Henle.   vision/sensitivity to patients with with IV • If oliguria or azotemia develops
80mg Excretion of   light   hepatic cirrhosis administration. or in- creases, drug may need to
*FREQUENCY: Every 6 potassium and (photophobia), rash, and in those EENT: blurred or be stopped.
to 8 hours ammonia are also pancreatitis, allergic to yellowed vision, • Monitor fluid intake and output
*ROUTE: PO increased white uric nausea,   sulfonamides. transient deafness, and electrolyte, BUN, and carbon
acid   diarrhea,   Alert: Drug may tinnitus. dioxide levels frequently.
excretion is   abdominal pain, cause tinnitus and Gl: abdominal •Watch for signs of hypokalemia,
reduced. It   and dizziness.  reversible or discomfort and pain, such as muscle weakness and
increases   Increased blood irreversible hearing diarrhea, anorexia, cramps.
plasma-renin   sugar and uric acid loss. Ototoxicity is nausea, vomiting, • Consult prescriber and dietitian
levels and   levels associated with constipation, about at high-potassium diet or
secondary   rapid injection, pancreatitis. potassium supplements.
hyperaldosteronism severe renal GU: azotemia, • Monitor glucose level in diabetic
may result.  impairment, use of nocturia, polyuria, patients.
Furosemide   higher-than- frequent urination, •Drug may not be well absorbed
reduces BP in recommended oliguria. Hematologic orally in patient with severe HF.
hypertensives as well doses, agranulo cytosis, Drug may need to be given IV
as in normotensives.  hypoproteinemia, aplastic anemia, even if patient is taking other oral
It also reduces or use with other leukopenia, drugs.
pulmonary   ototoxic drugs. • thrombocytopenia, • Monitor uric acid level,
oedema before Drug may anemia. especially in patients with a
diuresis has set in. exacerbate or Hepatic: hepatic history of gout.
activate SLE. dysfunction, • Monitor elderly patients, who
• Premature infants jaundice, increased are especially susceptible to
may be at liver enzyme levels. excessive diuresis, because
increased risk for Metabolic: volume circulatory collapse and
persistent patent depletion and thromboembolic complications
ductus arteriosus dehydration, are possible.
with furosemide asymptomatic • Monitor patients with severe
treatment during hyperuricemia, symptoms of urine retention due
first weeks of life. impaired glucose to bladder emptying disorders,
Dialyzable drug: tolerance, prostate enlargement, or urethral
No. hypokalemia, narrowing or worsening of
Overdose S&S: hypochloremic symptoms, especially during initial
Dehydration, blood alkalosis, treatment.
volume reduction, hyperglycemia, • Drug may increase fetal birth
hypotension, dilutional weight. Monitor fetal growth
electrolyte hyponatremia, during pregnancy.
imbalance. hypocalcemia, • Nephrocalcinosis and
PREGNANCY- hypomagnesemia. nephrolithiasis have occurred in
LACTATION- Musculoskeletal: premature infants and in children.
REPRODUCTION muscle spasm. Skin: younger than age 4 on long-term
• There are no dermatitis, purpura, furosemide therapy. Monitor
well-controlled photosensitivity renal function and renal
studies in pregnant reactions, transient ultrasounds. Look alike-sound
women. Use during pain at IM injection alike: Don't confuse furosemide
pregnancy only if site, toxic epidermal with torsemide. Don't confuse
potential benefit necrolysis, SJS, Lasix with Lonox, Lidex, or Luvox.
justifies potential erythema PATIENT TEACHING
risk to the fetus. multiforme. • Advise patient to take drug in
• Drug appears in Other: gout. morning to prevent need to
human milk. Use urinate at night. If a second dose
cautiously in is needed, tell patient to take it in
breastfeeding early afternoon, 6 to 8 hours after
women. morning dose.
• Inform patient of possible need
INTERACTIONS for potassium or magnesium
Drug-drug. supplements.
Aminoglycoside • Instruct patient to stand slowly
antibiotics, cis- to prevent dizziness and to limit
platin: May alcohol intake and strenuous
increase exercise in hot weather to avoid
ototoxicity. worsening dizziness upon standing
Use together quickly.
cautiously. • Advise patient to report all
Amphotericin B, adverse reactions and to
corticosteroids, immediately report ringing in ears,
corticotropin, severe abdominal pain, or sore
metolazone: May throat and fever; these symptoms
increase risk of may indicate toxicity. Alert:
hypokalemia. Discourage patient from storing
Monitor potassium different types of drugs in the
level closely. same container, increasing risk of
Antidiabetics: May drug errors. (The most popular
decrease strengths of furosemide and
hypoglycemic digoxin are white tablets that are
effects. Monitor about equal in size.)
glucose level. • Tell patient to consult
Antihypertensives: prescriber or pharmacist before
May increase risk taking OTC drugs.
of hypotension. • Teach patient to avoid direct
Use together sunlight and to use protective
cautiously. clothing and sunblock because of
Decrease risk of photosensitivity reactions.
antihypertensive
dose if needed.
Cardiac glycosides,
neuromuscular
blockers: May
increase toxicity of
these drugs from
furosemide-
induced
hypokalemia.
Monitor potassium
level.
Chlorothiazide,
chlorthalidone,
hydrochlorothiazid
e, indapamide,
metolazone: May
cause excessive
diuretic response,
causing serious
electrolyte
abnormalities or
dehydration. Adjust
doses carefully and
monitor patient
closely for signs
and symptoms of
excessive diuretic
response.
Ethacrynic acid:
May increase risk
of ototoxicity.
Avoid using
together. Lithium:
May decrease
lithium excretion,
resulting in lithium
toxicity. Monitor
lithium level.
NSAIDs: May
inhibit diuretic
response. Use
together
cautiously.
Phenytoin: May
decrease diuretic
effects of
furosemide. Use
together
cautiously.
Propranolol: May
increase
propranolol level.
Monitor patient
closely. Salicylates:
May cause
salicylate toxicity.
Use together
 cautiously.
Sucralfate: May
reduce diuretic and
antihypertensive
effect. Separate
doses by 2 hours.
 Choose 1 dosage, frequency, and route
 For the nursing responsibilities and patient teaching, choose only those related to the route chosen