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Loop Diuretics

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Loop Diuretics – Causseaux

My name is hannah castle a nurse practitioner student at auburn university today we’re going to learn all about loop diuretics drugs that fall under this pharmacologic class include bumetanide furosemide tor samad and at the chronic acid luke diuretics work in the nephrons of the kidneys in the loop of henle the drug bypasses the glomerulus is secreted directly into

The proximal convoluted tubules and works in the ace ending loop these diuretics bind to the nkc c2 transporter which is where one sodium one potassium and two chloride ions are normally reabsorbed from the urine back into the blood live diuretics block this reabsorption altering the tonicity of the cells and resulting in an increased volume a very concentrated

Urine output so let’s talk about the pharmacokinetics these drugs are absorbed in the gi tract seventy percent they’re distributed widely in the body and do cross the placenta and enter into breast milk they’re metabolized primarily in the liver inter excreted 80% in urine and minimally in breast milk and feces so what are the indications for this drug you would use

These loop diuretics in cases of heart failure pulmonary or peripheral edema nephrotic syndrome and hepatic disease the therapeutic effects that we’ll be looking for are diuresis a decrease in pulmonary and peripheral edema as well as a drop in blood pressure what we’re going to do right now is meet a patient who’s currently on lasix one of these loop diuretics

And we’re gonna quiz him on just how well he knows his drug let’s go meet roger what are some common side effects you can expect from your medication adverse drug reactions include orthostatic hypotension arrhythmias ohto toxicity electrolyte imbalances hyperglycemia renal failure in hypercholesterolemia are there any medications that you need to avoid while

You’re taking your lasix drug interactions include digoxin and lithium which increase the risk for toxicity in sets which decrease the effect of loop diuretics and warfarin which causes enhanced anticoagulation effects when combined with loop diuretics when with lasix be contraindicated mmm contraindications include anuria hepatic coma electrolyte imbalances in

A history of hypersensitivity to sulfonamides these drugs should be used cautiously in pregnant and breastfeeding women in diabetics and in cases of renal disease or cirrhosis of the liver what’s the best way for you to take your lasix loop diuretics should be administered first thing in the morning to avoid nocturia these drugs should also be taken before meals

To improve bioavailability if gi upset occurs these drugs can be taken with food what are some simple lifestyle modifications that you can make to help manage the effectiveness of your diuretic lifestyle management includes maintaining a weekly record of weights and monitoring any gains or losses consuming foods rich in potassium to avoid hypokalemia rising slowly

From a seated position to avoid injury due to orthostatic hypotension and avoiding alcohol while taking loop diuretics so when do we prescribe a loop diuretic lift diuretics are the diuretic of choice in combination with ace inhibitors for patients experiencing edema related to chf they are the second line diuretic for hypertension after thiazide diuretic therapy

Luke diuretics are first-line diuretic for hypertensive patients who have a gfr of less than 30 mls per minute so what do we monitor on these patients first you want to monitor the bu n the creatinine electrolytes uric acid and blood glucose prior to initiating therapy and again at 4 weeks watch the patient’s weight to assess for the effectiveness of diuresis

Monitor electrolytes for imbalances in any cardiac dysrhythmias monitor edema to assess fluid volume status assess for ototoxicity by asking the patient if they’re experiencing hearing loss ear pain or tinnitus and finally monitor the patient for the static hypotension by obtaining regular blood pressures with a patient lying sitting and standing let’s discuss

A few key takeaways monitor the patient closely for electrolyte and metabolic imbalances high doses of luke diuretics can trigger profound diuresis linking to hypovolemia and circulatory collapse and finally administer a lower dose of the diuretic in patients with hepatic dysfunction and a higher rate for patients with renal impairment

Transcribed from video
Loop Diuretics By Hannah Causseaux