Loop diuretics bumetanide

C. Although still highly controversial, the initial use of a thiazide diuretic for monotherapy has been recommended by the Joint National Committee on Detection, Evaluation and treatment of High Blood Pressure. Triamterene and Aldactone are rarely used alone and exhibit no antihypertensive activity. A recent study found that the loop diuretics bumetanide and furosemide effectively reduced blood pressure. Serum lipid levels were less affected than with thiazide diuretics or chlorthalidone. However, thiazide diuretics are a more conservative and approved approach for the initial treatment of hypertension that avoid the more dramatic fluid and electrolyte shifts that occur with loop diuretics. 

Loop diuretics bumetanide ethacrynate sodium ethacrynic acid furosemide... 

Three other loop diuretics Bumetanide and torsemide similar to furosemide ethacrynic acid not a sulfonamide ... 

The client diagnosed with essential hypertension is taking the loop diuretic bumetanide (Bumex). Which statement by the client would warrant notifying the client s health-care provider ... 

The loop diuretic bumetanide (Bumex) to a client diagnosed with essential hypertension. 

The loop diuretics, bumetanide, furosemide and torasemide, the potassium-sparing diuretic spironolactone, and the thiazides chlortalidone and chlorothiazide, have all been shown either not to interact or to cause only a small reduction in the effects of the coumarin anticoagulants of minimal or no clinical importance. The lack of reports of clinically relevant interactions su ests that, in general, diuretics do not interact with anticoagulants. The possible exception is etacrynic acid, which on rare occasions has caused a marked increase in the effects of warfarin. 

Loop diuretics Bumetanide, Etacrynic acid, Furosemide, Rretanide, Torasemide... 

M.J. Legorburu, R.M. Alonso, R.M. Jimenez and E. Ortiz, Quantitative determination of the loop diuretic bumetanide in urine and pharmaceuticals by high-performance liquid chromatography with amperometric detection, J. Chromatogr. Sci., 2001, 39, 425 30. 

Diuretics are needed to return to normal the expanded extracellular volume that other antihypertensive agents produce, such as fluid retention and blood volume expansion, via compensatory mechanisms of the body. The loss of efficacy of antihypertensive agents can be restored if a diuretic is used concomitandy. In the treatment of hypertension, high ceiling or loop diuretics, such as furosemide, ethacrynic acid, and bumetanide, are no more efficacious than the thiazide-type of diuretics. In fact, these agents cause more side effects, such as dehydration, metaboHc alkalosis, etc, and therefore, should not be used except in situations where rapid elimination of duid volume is cleady indicated. 

Potassium Sparing Diuretics. Triamterene and amiloride, potassium sparing diuretics, by themselves produce only slight antihypertensive effects. The main use is to prevent or to treat the hypokalemia induced by thiazide-type and high ceiling loop diuretics, such as furosemide and bumetanide. 

Loop diuretics are used cautiously in patients with renal dysfunction. The loop diuretics are Pregnancy Category B (ethacrynic acid and torsemide) and C drugp (furosemide and bumetanide) and must be used cautiously during pregnancy and lactation. Furosemide is used in children but should be used cautiously. The loop diuretics are used cautiously in patients with liver disease, diabetes, lupus erythematosus (may exacerbate or activate the disease), or diarrhea. Patients with... 

Loop diuretics, including furosemide, bumetanide, and torsemide are the diuretics of choice in the management of... 

Loop diuretics (furosemide, bumetanide, torsemide, and ethacrynic acid) are all equally effective when given in equivalent doses. Therefore, selection is based on the side-effect profile, cost, and pharmacokinetics of the agents. The incidence of ototoxicity is significantly higher with ethacrynic acid compared to the other loop diuretics therefore, its use is limited to patients who are allergic to the sulfa component in the other loop diuretics.15 While ototoxicity is a well-established side effect of furosemide, its incidence is greater when administered by the intravenous route at a rate exceeding 4 mg per minute.16 Torsemide has not been reported to cause ototoxicity. 

There are several pharmacokinetic differences between loop diuretics. Fifty to sixty percent of a dose of furosemide is excreted unchanged by the kidney with the remainder undergoing glucuronide conjugation in the kidney.17 In contrast, liver metabolism accounts for 50% and 80% of the elimination of bumetanide and torsemide, respectively.17 Thus, patients with ARF may have a prolonged half-life of furosemide. The bioavailability of both torsemide and bumetanide is higher than for furosemide. The intravenous (IV) oral ratio for bumetanide and torsemide is 1 1, bioavailability of oral furosemide is approximately 50%, with a reported range of 10% to 100%.18... 

The answer is c. (Hardman, pp 704-706J Triamterene produces retention of the K ion by inhibiting in the collecting duct the reabsorption of Na, which is accompanied by the excretion of K ions. The loop diuretics furosemide and bumetanide cause as a possible adverse action the development of hypokalemia. In addition, thiazides (e g, hydrochlorothiazide) and the thiazide-related agents (e.g., metolazone) can cause the loss of K ions with the consequences of hypokalemia. Triamterene can be given with a loop diuretic or thiazide to prevent or correct the condition of hypokalemia. 

Equipotent doses of loop diuretics (furosemide, bumetanide, torsemide, ethacrynic acid) have similar efficacy. Ethacrynic acid is reserved for sulfa-allergic patients. Continuous infusions of loop diuretics appear to be more effective and to have fewer adverse effects than intermittent boluses. An initial IV loading dose (equivalent to furosemide 40 to 80 mg) should be administered before starting a continuous infusion (equivalent to furosemide 10 to 20 mg/hour). 

Bumetanide is a loop diuretic indicated in oedema. Common side-effects of loop diuretics include hypokalaemia, hyponatraemia, hypotension and gout. 

Diuretics, specifically the loop diuretics furose-mide or bumetanide, combined with the thiazide like diuretic metolazone are needed in hypertensive urgencies both to lower blood pressure by removing excess volume and to prevent loss of potency from tendency to cause fluid retention. Volume depletion should be watched in patients on diuretics. 

Thiazide diuretics are not the drugs of choice in patients with renal insufficiency. In this situation, the loop diuretics furosemide and bumetanide are recommended they have greater intrinsic natriuretic potency than do the thiazides and do not depress renal blood flow. 

These are the most efficacious agents available for inducing marked water and electrolyte excretion. The peak diuresis is far greater than that observed maximally with other diuretics. The drugs in this group include furosemide, bumetanide and ethacrynic acid and the main site of action is the thick ascending limb of loop of Henle, thus they are often called loop diuretics. ... 

All the loop diuretics are rapidly absorbed from the GIT, usually within 30 minutes after oral, and 5 minutes after IV administration. The bio-availability of furosemide is about 60% while that of bumetanide is nearly 100%. They are extensively bound to plasma proteins, but they are rapidly secreted by the organic acid transport system of the proximal tubule. They produce a peak diuresis in about 2 hours with a total duration of diuretic action of 6 to 8 hours. 

The loop diuretics frusemide, torasemide, bumetanide, and ethacrynic acid (Table 12.4) inhibit the Na/K/2CI symporter by occupying the Cl- binding site. They decrease the reabsorption of Nan- by up to 20% of the total amount filtered. These drugs are powerful naturetics they can temporarily abolish Nan-... 

In addition to furosemide, bumetanide and torsemide are sulfonamide loop diuretics. 

---