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2011-10-10 00:23:30
Furosemide Lasix

Furosemide drug sheet
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  1. Furosemide: Trade Name:
  2. Furosemide Class:
    Sulfonamide-type loop diuretic
  3. 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).
  4. Furosemide Indications:
    • Pulmonary edema
    • CHF
    • Hypertensive Crisis
  5. Furosemide Contraindications:
    • Hypovolemia / Dehydration
    • Severe preexisting electrolyte imbalance (Hypokalemia)
    • Hypersensitivity to sulfonamides
  6. Furosemide Precautions:
    • 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
  7. 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
  8. 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
  9. Furosemide Onset:
    5 min, peak at 10-20 minutes
  10. Furosemide Duration:
    6-8 hrs
  11. Furosemide Side Effects:
    • Transient or permanent loss of hearing
    • Tinnitis
    • Hypovolemia
    • Hypotension
    • Hypokalemia (+ other electrolyte imbalances)
    • Hyperglycemia
    • Hyperuricemia
    • Weakness
    • Dizzines
  12. 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
  13. Furosemide PEARLS:
    • 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.