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Bumetanide Bumex Pharmacology

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I cover Bumetanide (Bumex) pharmacology, adverse effects, and drug interactions.

Hey all welcome back to the real life pharmacology podcast i’m your host pharmacist eric christensen thank you so much for listening today uh go check out snag your free 31 page pdf on the top 200 drugs it’s a great review if you’re practicing clinician or if you’re a student going through pharmacology classes board exams anything like

That it’s it’s really nice resource where i highlight some of the most important testable things as well as some of the most important clinical pearls and things that you’re going to actually see in real life so again 31 page pdf free to download no cost to you just simply an email and you’ll get updates on we’ve got new content new podcasts available and things

Like that too so go do that at all right so let’s get into the drug of the day today and that is bumatinide the brand name of this medication is bumx i can’t say i see it a ton in clinical practice but i definitely do see it from time to time this medication is a loop diuretic primary use you’re going to see it used for is edema there’s

Maybe a couple of rare cases where i’ve seen it for hypertension or something like that but by and large you see a patient on a loop diuretic you can guess most of the time that it’s going to be used for edema and running off fluid so how does it do that being a loop diuretic it’s going to block sodium and chloride reabsorption in the ascending loop of henle

In the kidney okay and ultimately by by blocking that reabsorption it’s going to go out through the urine and with that loss of water electrolytes are going to go with it so sodium potassium magnesium all that good stuff so uh that’s how the the drug works that’s how we run fluid off in a patient with chf for example and how the the medication is going to work

There one important thing that usually patients will find out the hard way if they weren’t adequately educated is thinking about the timing of that dose knowing that it’s a loop diuretic it’s going to run off fluid and the patient’s going to be peeing a lot more be sure we don’t get that dose too close to bedtime so the patient’s up all night now usually it only

Takes once or twice for a patient to realize this again if they weren’t properly educated because they don’t want to be up all night either going to the the bathroom so that’s one of the the primary adverse effects that patients really um care most about from a subjective uh situation and it’s always good to ask too if they’re skipping doses of their diuretics

Particularly if they’re having trouble with edema that’s a good question to ask how many times are you you skipping it because folks in social situations won’t want to have to go to the bathroom all the time and so sometimes depending upon how active they’re they are and what they do out in the community and things like that they will sometimes skip these doses

Maybe multiple days per week and so that can ultimately lead to a worsening of edema and potentially heart failure if you’re using it for that situation for example so really really important to remember that and the the social constraints and issues associated with using a loop diuretic like bumetanide other adverse effects muscle cramps if i have a patient report

That i’m definitely going to want to get electrolytes as well or at least make sure they’ve been done somewhat recently because as we reduce electrolytes as we get into a hypokalemic state for example uh the risk of muscle cramps and that adverse effect certainly goes up significantly uh running off fluid we’re gonna drop blood pressure so lower blood pressure

Could be a good thing but it could be a bad thing too if we drop it too far so pay attention to dizziness and significant drops in in blood pressure that are just too low um headache you might see those electrolyte reductions i certainly mentioned before potassium magnesium sodium one other thing to think about with the water loss is the risk for dehydration

So acute renal failure is a possibility if we get too aggressive with pumping fluid out of the body we can do it to an extent that it definitely damages the kidney other maybe more rare things increase in in uric acid well maybe it isn’t crazy rare but it’s sometimes something we just have to deal with because a lot of the diuretics potentially do this so you

Might have to watch that a little bit more closely with gout patients maybe we’ve got to do some dose adjustments with allopyranol or whatever they’re taking but it is important i think to at least pay attention to that and recognize that it might raise uric acid levels uh ototoxicity so that is a pretty rare adverse effect in in all honesty i haven’t seen it in

Practice uh very often at all um but there are some other drugs and stuff which i’ll talk about in drug interactions that that could increase that risk so again not not crazy common but as you escalate doses it is a dose-dependent effect so higher the dose more likely you could potentially see this rare adverse effect all right so let’s take a quick break from

Our sponsor and we’ll wrap up with drug interactions if you’re in the market for pharmacist board certification study material like bcps ambulatory care geriatrics bcm or the naplex exam go check out store story we’ve got a growing list of resources we’ve accumulated and added content over the years a great complete package really to help you

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Happen in clinical practice and that are going to be important to you as a practicing health care practitioner so again your support there with purchases at store directly helps this podcast all right so one quick note before i get into drug interactions i wanted to mention conversions this happens occasionally conversions between loop diuretics

So the classic loop diuretic is lasix brand name lasix generic name furosemide and a 40 milligram dose is approximately equivalent to one milligram of bumatinide okay so bumetinite is obviously a lot more potent because it takes less of the drug to do similar effects so just wanted to throw that conversion out there i have seen that come up in in pharmacology

Classes throughout pharmacy school and things like that so good conversion just to kind of have in your head or at least kind of have heard it before all right so let’s finish up with those drug interactions so first off i think about diuresis and drugs that are going to add to that effect so any other diuretics thiazide diuretics potassium sparing diuretics

Maybe even a drug class of drugs like the sglt2 inhibitors can have a diuresis type effect that’s going to potentially add to that so that could drop blood pressure further that’s an additive effect certainly and it could also increase the risk for dehydration and renal impairment so really really important to i think pay attention to that sticking on the topic

Of renal impairment ace inhibitors arbs nsaids when you start combining these with a loop diuretic like brumetonide we’re going to increase the risk of renal impairment so really really important to monitor that kidney function for sure lithium concentrations can go up with a drug like pumpetnide important to monitor that in our bipolar patients blood pressure

Effect i certainly mentioned already a little bit any blood pressure med we add it’s going to lower blood pressure further we’re probably intentionally trying to do that but we can certainly lower it too far so think of your beta blockers calcium channel blockers and and so on and so forth there in addition we’ve got plenty of other drugs that lower blood pressure

So cinema is kind of my always my classic example of a drug that can cause hypotension so pay attention to that and we certainly could have some additive effects we’re simply going to monitor is what we’re going to do check blood pressures and obviously look for dizziness and signs of hypotension ototoxicity so there’s one classic uh group of drugs that can cause

Ototoxicity so ear toxicity and that is the aminoglycosides so gentamicin tobramycin things like that so that can definitely have an additive risk as far as ototoxicity goes and also keep in mind aminoglycosides are nephrotoxic as well so we could have some additive risks there as well lowering magnesium levels bumetanide certainly does that we could have some

Additive effects with a drug like omeprazole for example so the ppis can potentially lower magnesium levels and if pumitinide is added on top of that could lower that further and put a patient’s patient into a low magnesium type of state and then i wanted to mention the opposition of the benefit from bumetnine so what what the heck am i talking about there so

Think about drugs that can worsen heart failure worsen edema type situations so nsaids are going to be the most common one you should think about there another fairly common group of meds are the gabapentoids so your gabapentin your pregabalin okay diabetes pioglitazone uh that’s those are all good examples of drugs that are going to oppose or potentially cause

The prescribing cascade where you start an nsaid and two weeks later now you need bumetonide to get rid of edema so keep those uh polypharmacy prescribing cascade examples in mind they happen all the time in clinical practice and go check out my my book perils of polypharmacy i go through tons of those examples great examples there that can really help you

Start to get train your brain to think a little bit differently when you see new symptoms and that type of thing so um with that i think that’s going to wrap up the podcast for today thank you so much for listening if you enjoyed this episode found it helpful leave a rating review on itunes or wherever you’re listening i’m greatly appreciative of that certainly

Support the sponsor store if you find something uh useful uh there that goes your purchases there go directly to help support this podcast if you want to reach out to me you can find me on linkedin otherwise med education 101 all right well i’m going to wrap it up for today thank you so much for listening uh one last thing go subscribe at and get your free little study guide pdf of the top 200 drugs thank you so much for listening hope you have a great rest of your day

Transcribed from video
Bumetanide Bumex Pharmacology By Eric Christianson