nop DIURETICS ure Fexersion of Mination with thie type duet 1 are used to fold volume to make it easter forthe heat to pump. Loop diuretics lock sodium and chloride option in the thick ascending imb ofthe loop of Henle interfering with the chloride: binding co-transport systems, They P 1 sodium, potassium, chloride, magnesium, calcium, and water, They are used to reduce congestive symptoms Sa ad restore euvolemla (or “ry” welgh- Loop dures ave not been shown alter the uh ore patents, Dut most patents require them for symptom control. Care must be taken not to over-iurese patents, a mea tbypotension or enal impairment the owes efetv dose shouldbe used, the response tothe loops poor such as metolazone, canbe usefUl. Loops ean be used or BP redition tn patients ‘ep Coue Book | fsfep © 208, fihep ©2012 of stable ena mmpairment when other options are not adequate. DOSING (ra 20-40 mg daly or BID Max 600 g/day ‘Ora 0.5-1 ng daly or BID Max 10 m5/dey (On 10-20 mg daly Mox 200 mg/day hocrync Ae (Edecen) Tel jecton rc $0-200 m9 dai or Sided Mx 400 mg/day SAFETY/SIDE EFFECTS / MONITORING ‘BOXED WARNING Can odo polcurd dures resuing nid ond elecrolye depletion ‘CONTRAINDICATIONS Aura WARNINGS Sully [nl tayo costae ~ 28 coutonory slotting Alri ‘Adverse Dr Roactons cpt his warning dous at analy oar id SwDE erFECTS. Lic No.4 Mg, Ct colorant thonthaxils wich Co), HCO anil Stes necitaf [F Un cone FBG Tox Fat ‘holeoolothosate hppoenton, phtotenivy, olor nore wih efoeryne i} including Peon los, Fav ond vorig MONITORING Rona unto Fu sous np ond ovpu weigh}, BF slarohios, ovileay {sting wih igh doves rropid Yodan «/sx 1 HE Nores Take ary inthe doy to void noc. ‘St rosamide jain wom np eigeration causes crys to form, which iraydstove vpon worming. Do rol vse froveide stor thoy are yo in ¢elor must be ceo Fzctemide ond buneloid or ight sents fn amber bot nt roqie ah proton. Vaden do Deve conversions (Or avira dosing: hrormide 40 ma * bunetande 1 mg “osenide 20 thre ocd 50. [wound 1.0 rat 1.2 roromide 20mg IV ~ furosemide 40.mg PO} Bumetanide, sami ond ehocryaic oid VFO rt 1:1 Loop Diuretic Drug Interactions. * Avoid NSAIDs (including COX-2 inhibitors) in patients with HE.NSAIDs T sodiumand water retention, which | theeffect ofthe loop diuretis and can lead to renal impairment. * Can acutely 4 blood pressure risk for additive hypotension with other drugs that lower blood pressure. Monitor BP carefully Combining loop diuretics with ACE inhibitors or ARBs can cause severe hypotension and worsening renal function, Monitor BP and renal function carefully ‘The combination of aloop anda thazide-ype diuretic may Aturetie response. Electrolyte abnormalities are more ely and must be monitored closely Can T the ototoxic potential of other ototoxie drugs (see Drug Interactions chapter), especially in patients with impaired renal function. This combination should be avoided if possible 1 Diuretics ean 4 renal clearance of ithium and 1 risk of Iithium toxicity