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Furosemide: Trade Name:
Sulfonamide-type loop diuretic
Furosemide Mechanism of Action:
- Inhibits reabsorption of sodium and chloride in the ascending limb of the loop of Henle, resulting in an increased excretion of sodium, chloride, & water.
- Increases renal excretion of potassium, hydrogen, calcium, magnesium, bicarbonate, ammonium, and phosphate.
- It also causes decreased peripheral vascular resistance and increased peripheral venous capacitance, resulting in a subsequent decrease in left ventricular filling pressure (preload).
- Pulmonary edema
- Hypertensive Crisis
- Hypovolemia / Dehydration
- Severe preexisting electrolyte imbalance (Hypokalemia)
- Hypersensitivity to sulfonamides
- Diabetes mellitus (may worsen control)
- Renal disease
- Hepatic Disease
- Anuria (listed as a contraindication in one source)
- Pregnancy (C) (no well-controlled studies, possible fetal abnormalities)
- May cause electrolyte imbalances
Furosemide Dosage Adults:
- CHF/Pulmonary edema: Slow IV/IM 20-80 mg, may increase to up to twice the patient’s daily dose of oral furosemide.
- HTN CRISIS: (Medical Control Order) 20-80 mg slow IV push (each 20 mg over 1-2 minutes), usual dose 40mg
Furosemide Dosage Pediatrics:
(Not part of ACEMSS SWO’s) 0.5-1 mg/kg IV/IM (some texts reference a dosing range of 1-2 mg/kg) Max of 6mg/kg/day
5 min, peak at 10-20 minutes
Furosemide Side Effects:
- Transient or permanent loss of hearing
- Hypokalemia (+ other electrolyte imbalances)
Furosemide Interactions: Incompatible with any drug in syringe Additive effects--antihypertensives, nitrates, other diuretics
- Incompatible with any drug in syringe
- Additive effects--antihypertensives, nitrates, other diuretics
- The secret to avoiding transient/permanent deafness or tinnitis when administering furosemide is to administer it SLOWLY! "Ototoxicity increased proportionately as the rate of infusion of parenteral furosemide increased from 4 mg/min (no ototoxicity), to 5.6 mg/min (no ototoxicity), to 25 mg/min (9/15 patients developed reversible hearing loss), to 67 mg/min (10/10 patients developed tinnitus and deafness that persisted for 90 minutes)." DeVito JM, Vance JR. Furosemide-associated ototoxicity. Clin Pharm 1983;2:507—9.
- When administering the medication to a pregnant patient, the benefits must outweigh the risks (life or limb situation)
- In the prehospital setting, furosemide should be administered IV if at all possible.
- The initial effects from increased venous capacitance should be seen within about 5 minutes. Diuresis will begin within 15-30 minutes after administration.
- Per ACEMSS SWO you may double the patient’s normal PO dose.