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dosing must be adjusted to patient's needs Use caution in systemic lupus erythematosus, liver disease, renal impairment Concomitant ethacrynic acid therapy (increases risk of ototoxicity) Risks of fluid or electrolyte imbalance (including causing hyperglycemia, hyperuricemia, gout), hypotension, metabolic alkalosis, severe hyponatremia, severe hypokalemia, hepatic coma and precoma, hypovolemia (with or without hypotension) Do not commence therapy in hepatic coma and in electrolyte depletion until improvement is noted IV route twice as potent as PO Food delays absorption but not diuretic response May exacerbate lupus Possibility of skin sensitivity to sunlight Prolonged use in premature neonates may cause nephrocalcinosis Efficacy is diminished and risk of ototoxicity increased in patients with hypoproteinemia (associated with nephrotic syndrome); ototoxicity is associated with rapid injection, severe renal impairment, use of higher than recommended doses, concomitant therapy with aminoglycoside antibiotics, ethacrynic acid, or other ototoxic drugs To prevent oliguria, reversible increases in BUN and creatinine, and azotemia, monitor fluid status and renal function; discontinue therapy if azotemia and oliguria occur during treatment of severe progressive renal disease FDA-approved product labeling for many medications have included a broad contraindication in patients with a prior allregic reaction to sulfonamides; however, recent studies have suggested that crossreactivity between antibiotic sulfonamides and nonantibiotic sulfonamides is unlikely to occur In cirrhosis, electrolyte and acid/base imbalances may lead to hepatic encephalopathy; prior to initiation of therapy, correct electrolyte and acid/base imbalances, when hepatic coma is present High doses ( 80 mg) of furosemide may inhibit binding of thyroid hormones to carrier proteins and result in transient increase in free thyroid hormones, followed by overall decrease in total thyroid hormone levels In patients at high risk for radiocontrast nephropathy furosemide can lead to higher incidence of deterioration in renal function after receiving radiocontrast compared to high-risk patients who received only intravenous hydration prior to receiving radiocontrast Observe patients regularly for possible occurrence of blood dyscrasias, liver or kidney damage, or other idiosyncratic reactions Cases of tinnitus and reversible or irreversible hearing impairment and deafness reported Hearing loss in neonates has been associated with use of furosemide injection; 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treatment during pregnancy necessitates monitoring of fetal growth because of risk for higher fetal birth weights Lactation: Drug excreted into breast milk; use with caution; may inhibit lactation Loop diuretic; inhibits reabsorption of sodium and chloride ions at proximal and distal renal tubules and loop of Henle; by interfering with chloride-binding cotransport system, causes increases in water, calcium, magnesium, sodium, and chloride Solution: Fructose10W, invert sugar 10% in multiple electrolyte #2 Additive: Amiodarone (at high concentrations of both drugs), buprenorphine, chlorpromazine, diazepam, dobutamine, eptifibatide, erythromycin lactobionate, gentamicin(? ), isoproterenol, meperidine, metoclopramide, netilmicin, papaveretum, prochlorperazine, promethazine Syringe: Caffeine, doxapram, doxorubicin, eptifibatide, metoclopramide, milrinone, droperidol, vinblastine, vincristine Y-site: Alatrofloxacin, amiodarone (incompatible at furosemide 10 mg/m L; possibly compatible at 1 mg/m L), chlorpromazine, ciprofloxacin, cisatracurium (incompatible at cisatracurium 2 mg/m L; 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Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information. Diuretics Hypokalemia Practice Essentials, Pathophysiology, Hypokalemia NCLEX Review Notes
     
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