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Furosemide

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VOL: 102, ISSUE: 07, PAGE NO: 31

GENERIC AND PROPRIETARY NAMES

- Furosemide.

- Lasix.

ACTION

- Inhibits reabsorption from the ascending loop of Henle in the renal tubule.

CLASSIFICATION

- Loop diuretic.

INDICATIONS

- Pulmonary oedema due to left ventricular failure.

- Chronic heart failure.

- Diuretic-resistant oedema, with the exception of lymphoedema or oedema due to peripheral venous stasis or calcium-channel blockers.

- Hypertension resistant to thiazide therapy.

- Oliguria due to renal failure.

CONTRAINDICATIONS

- Precomatose states associated with liver cirrhosis.

- Renal failure with anuria.

CAUTIONS

- Hypotension. 

- Oliguria unless hypovolaemia has been corrected.

- Enlarged prostate.

- Porphyria.

- Renal or hepatic impairment.

- Pregnancy.

COMMON SIDE-EFFECTS

- Hyponatraemia, hypokalaemia, hypomagnesaemia. 

- Hypochloraemic alkalosis.

- Increased calcium excretion.

- Hypotension.

- Nausea.

- Dizziness.

RARE SIDE-EFFECTS

- Gastrointestinal upset. 

- Hyperuricaemia.

- Gout.

- Hyperglycaemia.

- Rash.

- Photosensitivity.

INTERACTIONS

- NSAIDs.

- Lithium.

- Digoxin.

- Some antibiotics.

- ACE inhibitors.

ADMINISTRATION

- Oral. 

- Intramuscular injection.

- Slow intravenous injection.

NURSING CONSIDERATIONS

- Furosemide is often given in conjunction with a potassium supplement or a potassium-sparing diuretic to counteract potassium loss.

- The medication has a rapid onset of effect of about one hour when taken orally and five minutes by injection.

- Duration of action is about six hours so it is possible to use a twice daily dose if necessary.

PATIENT TEACHING

- Explain to patients that furosemide controls high blood pressure but does not cure it and therefore they need to continue with the medication even if they feel well.

- Advise patients not to stop taking furosemide without consulting the prescribing health care professional.

- Health education should be given regarding diet and exercise.

- Advise patients who miss a dose to take the missed dose as soon as remembered. However, if it is almost time for the next dose, skip the missed dose then continue with the regular dosing schedule. Patients should not take a double dose to make up for a missed one.

- Warn patients about an increased frequency of micturition. This may last for up to six hours after a dose and should decrease after they have taken furosemide for a few weeks.

Nurses should refer to manufacturer’s summary of product characteristics and to appropriate local guidelines.

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