picture lasix online lasix water pill, eye lasix oregon surgery, horse racing lasix, lasix drug, lasix medicine, canine lasix, lasix sale, eye lasix surgery washington, lasix injection, vancouver lasix eye surgery
| canine lasix eye lasix surgery toronto lasix 40mg horse it lasix use why lasix manufacturer lasix renal scan lasix eye surgery virginia lasix sale lasix online lasix plus eye lasix salem surgery lasix for dog lasix drug lasix oregon lasix for cat lasix vancouver | lasix Geriatric Times © Geriatric Times. All rights reserved. A Fresh Look at Diuretics by Arline Kaplan Geriatric Times March/April 2001 Vol. II Issue 2 Although physicians have relied on lasix iv diuretics to treat hypertension and edema for more than 50 years, there are still new techniques and fine points to learn, particularly when using diuretics to treat older adults, according to nephrologist Christian W. Mende, M.D. Mende-clinical professor of medicine at the University of California, San Diego, and lasix iv board certified in internal medicine, nephrology, geriatrics and hypertension-discussed techniques to improve the efficacy lasix iv and safety of diuretics at the Second Annual U.S. Geriatric & Long-Term Care Congress in Las Vegas. "Diuretics are actually compounds that increase the urinary salt excretion, and water just happens to come along," he said. "Chemically, diuretics are organic anionic compounds." Each lasix iv class of lasix iv diuretics has a distinct site of action in the nephron (Figure). For example, acetazolamide (Diamox) works in the lasix iv proximal tubule. Furosemide (Lasix), bumetanide (Bumex), ethacrynic acid lasix iv (Edecrine) and torsemide (Demadex) work in the loop of Henle. Thiazide diuretics, such as metolazone (Mykrox, Zaroxolyn), chlorthalidone (Hygroton) and hydrochlorothiazide (Hydrodiuril, Microzide), block the reabsorption of sodium in the early distal tubule. Potassium-sparing(K-sparing) diuretics, such as amiloride (Midamor) lasix iv (in combination with hydrochlorothiazide in Moduretic), triamterene (Dyrenium) (in combination with hydrochlorothiazide in Maxzide, Dyazide) and spironolactone (Aldactone) (in combination with hydrochlorothiazide in Aldactazide), act in the collecting duct, thereby preventing some of the exchange of sodium for potassium that occurs in this portion of the nephron. lasix iv The K-sparing diuretics, Mende added, are sodium channel blockers. All diuretics are secreted by the proximal tubule and are effective from the luminal site of tubules, thus blocking the reabsorption of salt and water. As soon as diuresis is induced, the body begins to counteract that process (Mende, 1990). "Your body very quickly, by the second and third doses, has less of a response to the diuretic," Mende explained. It lasix iv tries to preserve intravascular volume through renin secretion, increased filtration fraction, lasix iv a decrease in renal cortical blood flow, activation of the renal tubular sodium/potassium pump and aldosterone secretion. To help reduce the body's lasix iv defensive response, lasix iv physicians may use two or three different types of diuretics at the same time. "You use a loop diuretic plus a thiazide together, and you could add triamterene or Aldactone to that. Then you have three different lasix iv diuretics blocking; we call this lasix iv sequential nephron lasix iv blocking," said Mende. This sequential blocking process lasix iv should occur only in the hospital, lasix iv he added, since patients are likely to lose lasix iv a lasix iv lot of potassium, and their electrolytes need to be monitored lasix iv carefully. Mannitol and Acetazolamide Following his introductory remarks, Mende discussed appropriate lasix iv and inappropriate uses of lasix iv specific diuretics. The osmotic diuretic mannitol lasix iv can only be given intravenously, he said. It is used lasix iv primarily in trauma when patients are experiencing hypotension and oliguria, during renal artery or aortic aneurysm repair, in reduction of lasix iv brain edema from trauma, as an antidote for ciguatera poisoning (a gastrointestinal and neurological syndrome that accounts for 25% lasix iv of all food poisoning from fish), and for rhabdomyolysis, which can occur in cocaine use or result from a crush injury. Mannitol is not used in an edematous state, however, because it does not promote sodium excretion to a great extent. It is, therefore, of limited use in congestive lasix iv heart failure (CHF). Mende next discussed acetazolamide, a carbonic anhydrase inhibitor that inhibits lasix iv hydrogen ion secretion and lowers serum bicarbonate levels. "A lasix iv patient who goes on Diamox has a very alkaline lasix iv urine, with bicarbonate loss, and the serum bicarbonate drops," Mende said. The diuretic action of acetazolamide stops with serum bicarbonate levels below 22 mEq/L, however. Clinical uses of the diuretic include alkalization of the urine in myoglobinuria lasix iv (e.g., crush injuries, cocaine lasix iv abuse) and lasix iv in uric acid nephropathy, as well as lasix iv in lasix iv aspirin or barbiturate overdose. One of Mende's favorite uses of the drug is as an adjunct in refractory CHF for hospitalized patients receiving large doses of furosemide and lasix iv thiazides. If they are on metolazone plus furosemide or a thiazide comorbation, they develop contraction alkalosis, and their serum bicarbonate levels can go up to 30 mEq/L or higher, he stated. "So you add now Diamox, lasix iv 250 mg every eight hours, to the Lasix and thiazide. You will achieve another liter or lasix iv two of lasix iv urine; lasix iv in addition, you will lower the bicarb [level] from 40 down to 30 down to 25. lasix iv And after two or three days, you have normal lasix iv acid-based status and additional diuresis," lasix iv he said. lasix iv "And when you do that, you [had] better use 100 lasix iv [mEq] lasix iv or 150 mEq of potassium daily." Acetazolamide, according lasix iv to Mende, lasix iv is also useful lasix iv in high-altitude sickness. It induces a metabolic acidosis which stimulates the respiratory drive and diminishes altitude-induced hypoxemia. Rare side effects of acetazolamide are paresthesias, kidney stones (citrate deficiency) and encephalopathy with coma. "I have seen two cases and [am aware of] lasix iv 30 reports of coma on Diamox…So if somebody develops coma, is aged 75 or older and was started on Diamox, think of that as a rare lasix iv cause of drug-induced coma. When you stop the Diamox, the patient wakes up," he said. With all diuretics, Mende warned, creatinine levels and electrolytes, including magnesium, should be closely monitored. "If you use hydrochlorothiazide for hypertension and edema in a patient with creatinine levels above 2 mg/dL, little happens. It just doesn't work anymore if the patient's kidney function is less than 30%," he said. "Metolazone usually lasix iv costs four times as much as hydrochlorothiazide, but metolazone works all the way to 10% of kidney function. lasix iv So if lasix iv you have a creatinine [level] of 2 [mg/dL] or higher, and you need a diuretic, you have two choices, metolazone or all the lasix iv loop diuretics. Chlorthalidone is much longer acting (up to 36 hours). I lasix iv have seen the worst hypokalemias lasix iv ever lasix iv with it because this drug never quits working," Mende said. If thiazides are used for hypertension and to reduce urinary calcium excretion by 50% in calcium oxalate stone formers, doses of 12.5 mg qd to 25 lasix iv mg qd of hydrochlorothiazide are sufficient, lasix iv according to Mende. "If you go lasix iv to lasix iv the huge doses like we used to do 10 lasix iv to 15 lasix iv years ago, all you get is hypokalemia, hypomagnesemia and complications like high uric acid levels. So the way to go is to use low doses," he said. Eventually, in hypertension, the hydrochlorothiazide dose should be reduced to 6.25 mg qd or 12.5 mg qd, since it is lasix iv then being used lasix iv as a vasodilator rather than a diuretic. The number-one side effect of thiazides is mild lasix iv hypercalcemia. "If you see someone with an elevated calcium, look at their drugs, and they are usually on a thiazide. If that is the case, lasix iv don't do lasix iv any workup; stop the thiazide; and give them Lasix or Bumex, which reduce calcium. If the calcium comes lasix iv back to normal [8.4 mg/dL to 10.6 mg/dL], it was the lasix iv thiazide. If the calcium does not come back to normal within lasix iv a week, that person deserves a parathyroid test, looking for hyperparathyroidism." Other side lasix iv effects of lasix iv thiazides include photosensitivity and, rarely, leukopenia and lasix iv pancreatitis. Loop Diuretics Although furosemide, bumetanide, lasix iv ethacrynic acid and torsemide work at different sites, lasix iv Mende stated, "If you give lasix iv someone 40 mg per day of Lasix and at the same time 2 mg per day of Bumex, lasix iv you are lasix iv wasting one…please decide which one you want to use." Clinical uses of the loop diuretics include azotemia, acute renal failure with oliguria, acute pulmonary edema, hyponatremia, hypercalcemia (as long as you accompany therapy lasix iv with a saline infusion) and congestive heart failure. The loop diuretics "are very potent even in people with terrible kidney function," Mende said. He explained that the higher the patient's creatinine levels, the higher the dose of loop diuretics needed. "With Lasix, you can give lasix iv 140 mg to 160 mg IV, and then go to lasix iv 200 mg to 300 mg of Lasix IV for 24 hours lasix iv for patients with reduced renal function," he said. For patients with acute pulmonary edema, Mende lasix iv said he uses IV bumetanide, which works within five minutes. It serves as a vasodilator, lowers intrathoracic pressure and stimulates prostaglandin. For patients with CHF, Mende said lasix iv he generally uses a loop diuretic instead of a thiazide, because, "you need a powerful diuretic to deal with the edema, low cardiac output and reduced renal function." Frequently, Mende lasix iv will combine types of diuretics. While thiazides don't generally work with serum creatinine levels above 2 mg/dL, they do work if they are combined with loop diuretics, he said. Mende generally uses a twice-daily dose of loop diuretics when treating patients with CHF. "You are better off to dose bid, because the drug only works lasix iv for eight hours and the other 16 hours, the kidneys hold onto salt and water," he lasix iv said. While loop diuretics can improve hyponatremia, Mende warned that if the patient's sodium falls lasix iv below 120 mEq/L, do not attempt to correct the levels in one lasix iv day. If you do it faster than lasix iv 12 mEq/L per 24 hours, the patient may develop a lasix iv syndrome called central pontine myelinolysis, which can lasix iv lead to irreversible degeneration of nerve fibers. For patients with reduced renal function lasix iv or renal failure or following open-heart lasix iv surgery, Mende said it lasix iv is appropriate to lasix iv consider continuous infusion of loop diuretics after an IV bolus (e.g., 5 mg of IV Bumex or 100 mg or 200 mg of IV Lasix). "Once they have a good diuresis, you can lasix iv then hang up a drip of 1 mg of Bumex per hour, or 20 [mg] of Lasix IV per hour…What is the magic of the continuous lasix iv drip? The magic is the urine volume is 10% greater and the sodium excretion is 20% greater than intermittent dosing…But you need to start bolusing first," he said. "I see this mistake all the time. If you hang up a drip of 1 mg of Bumex or 20 mg of Lasix per lasix iv hour right off the bat, without an initial bolus, lasix iv it will take you lasix iv four to five hours to start to see diurese." Specific side effects of loop diuretics, according to Mende, include rare interstitial nephritis (with furosemide) and ototoxicity in high doses, particularly with aminoglycocide cotreatment. Potassium-Sparing Diuretics The K-sparing diuretics are weak diuretics alone, Mende explained, because they work in the collecting ducts lasix iv where only 3% of the filtered load is processed. They are primarily used as adjuncts to lasix iv thiazides and loop diuretics or for potassium and magnesium spacing. Instead of lasix iv using thiazides alone for hypertension, Mende suggested combining with triamterene. Spironolactone is making a tremendous lasix iv rebirth, Mende said, because it reduces scarring and fibrosis in the heart. By reducing scarring and fibrosis, you are also reducing the arrhythmias seen with CHF. Amiloride lasix iv can be used for magnesium deficiency because it increases renal reabsorption. If you have somebody who has hypomagnesemia, lasix iv and you can't give them enough magnesium orally, because of laxative action, give amiloride, Mende suggested. Also, amiloride is useful for patients taking lithium who lasix iv have polyuria and complain of having to get up three or four times at lasix iv night. At a dose of 5 mg bid, amiloride reduces urine volume by 30%, Mende said, adding that loop or thiazide diuretics are contraindicated in patients taking lithium, because the drugs alter lithium lasix iv levels. "Don't use any K-sparing diuretics with angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers [or] nonsteroidals," Mende warned. He also cautioned against using them when serum creatinine levels are above 2 mg/dL. Specific side effects seen with K-sparing diuretics include hyperchloremic acidosis; hyperkalemia, lasix iv especially if lasix iv administered lasix iv with an ACE inhibitor, angiotensin II receptor blocker or in patients with diabetes; gynecomastia, impotence in men or irregular menstrual cycles in women (only with use of spironolactone); folic acid deficiency (with chronic use of lasix iv triamterene); or acute renal failure (with triamterene when used with indomethacin [Indocin]). Throughout his talk, Mende offered some general guidelines to clinicians. Tell your patients that they can neutralize every single diuretic by high salt intake, so tell them to take it easy lasix iv on lasix iv salt and to drink only when they are thirsty, unless they are lasix iv exercising. Potassium levels should be lasix iv maintained at 3.5 mEg/L or higher in coronary artery lasix iv disease with a history of arrhythmias, lasix iv during lasix iv anesthesia, and in patients who have diabetes or hypokalemia. Magnesium levels should also be in the high normal range to suppress arrhythmias, particularly in the post myocardial infarction patient. Nearly all diuretics are derivatives of sulfa drugs. For patients who have a rare cross-reactivity and lasix iv who have hypertension or CHF, Mende relies on ethacrynic acid for patients allergic lasix iv to sulfa-containing diuretics. Recognize that nonsteroidal agents reduce diuretic efficiency by up to one-third because they hold on to salt and water and they lasix iv block prostaglandins. For lasix iv patients with lasix iv severe CHF who are receiving diuretics, do not forget the value of bed rest, lasix iv elevation of lasix iv the legs and the use of compression (elastic bandage, stockings) to mobilize fluids. Reference Mende CW (1990), Current issues in diuretic therapy. Hosp Pract (Off Ed) 25(suppl 1):15-21 [see discussion pp30-31]. Enable Javascript to correctly view this page. Send this page to a friend Get lasix iv information about obtaining a printed copy of this publication.For inquiries specific to this document, refer to the volume/issue date at the top of this lasix iv page. Permission to repost lasix iv or reprint any material on this site must be obtained by contacting the . Select Your Destination--> --------------- MHI Home Page MHI's Awards and Recognition --------------- About CME LLC CME InfoStore Help! Customer Service Online Search MHI Site Map --------------- Annual Congresses Ask the Expert Ask the Medical Expert Bipolar Disorders lasix iv Information Center Classifieds CME Conferences CME lasix iv Home Study Catalog CME Online Courses CME Search Controversy in Medicine Poll Depression infoCenter Disorder Index Geriatric Times Healthier You Issues in Aging Medical Congress The Journal (NAMI California) Medical Book lasix iv Locator MEDInfoSource Mental Health Conferences MH Address Book MH Calendar MH Book Locator MH Connections - Lists, Newsgroups MH Directory of Web Sites Multimedia Library NARSAD NARSAD Artworks Psychiatric Times Resources for Professionals Schizophrenia and Other Psychotic Disorders Track Your CME (FREE!) U.S. Psychiatric & Mental Health Congress Copyright lasix iv 1995-2005 CME LLC Terms of Service. Renal failure (Commonly used agents): dosing list for health care providers, pharmacists, nurses, physicians. GlobalRph Global reach through the power lasix iv of the Internet… Renal Failure This document Copyright © 2003 D.McAuley, GlobalRPh Inc. All Rights Reserved. Renal failure/Oliguria lasix iv (General guidelines) (1) Avoid magnesium containing lasix iv products (Maalox etc), NSAID’s, and lasix iv nephrotoxins. (2) Consider fluid challenge to rule out pre-renal azotemia if not fluid overloaded. (3) Lasix: IV bolus 10-200 mg (usually every 2 hours). Doses > 200mg should be infused at 4 lasix iv to 10 mg/min (usually 4 mg/min) to minimize ototoxicity. IV infusion of 0.25 to 0.4 mg/kg/hour titrated to urine output. (4) Metolazone (Zaroxylyn ® ) 5-10 mg po qd (max 20 mg/day) lasix iv (5) Bumetanide lasix iv (Bumex ®): IV bolus 0.5 to 4mg over 1-2min prn (usually q2-3 hr). IV infusion: usually 0.5 to 1 mg/hr. T1/2= 1 to 1.5hr Duration of action: 2-4hrs. (6) Torsemide (Demadex ®): IV bolus: 5 to 100 mg over 1-2 minutes. lasix iv IV infusion: 5 to lasix iv 20 mg/hr. [1 mg Bumex] = [10-20 lasix iv mg Demadex] = [40 lasix iv mg Lasix] (7) Mannitol: When instituting treatment with mannitol in patients with marked oliguria, a test dose should be used. Infusion of lasix iv 0.2 grams/kg over 3 lasix iv to 5 min should lasix iv produce a diuresis of at least 30 to 50 ml/hr. A second test dose may be given if no response is seen—if no response lasix iv with second dose—do lasix iv not use. To treat oliguria: 12.5 to 25 grams IV every 2 to 4 hours. A 15 to 20% solution may be used. Rate should be adjusted to maintain urinary output at 30-50 ml/hr. (Usual test dose= 12.5 grams over 3 to 5 minutes. ) paricalcitol (Zemplar): Indicated for the prevention and treatment of lasix iv secondary hyperparathyroidism associated with chronic renal failure. Synthetic lasix iv vitamin D analogue. Dosing: 0.04 to 0.1 mcg/kg (2.8 to 7.0 mcg) IV 3 times/week at dialysis. Max dose 0.24 mcg/kg (16.8 mcg) sevelamer (Renagel): Calcium/aluminum free phosphate binder. Hyperphosphatemia: 2-4 caps orally three times daily with meals. Calcium lasix iv acetate(PhosLo): lasix iv Hyperphosphatemia: Start 2 tablets with each meal. Range: 2 to 4 tablets with each meal. [667mg tab] Doxercalciferol (Hectorol) Management of secondary hyperparathyroidism in patients undergoing chronic renal dialysis. Synthetic vitamin D analog. Initial dose of doxercalciferol is 10 mcg administered three times weekly at dialysis. The maximum recommended dose lasix iv of doxercalciferol is 20 mcg administered three times a week at dialysis for a total of 60 mcg/week Ferric Sodium Gluconate Injection (Ferrlecit) Indicated for the treatment of iron deficiency anemia in patients undergoing chronic hemodialysis lasix iv who are receiving supplemental lasix iv erythropoietin therapy. The recommended dosage of ferric sodium gluconate for the repletion treatment of iron deficiency in hemodialysis patients is 10 mL of ferric sodium gluconate (125 mg of elemental iron) diluted in 100 mL of 0.9% sodium chloride solution administered intravenously over 1 hour. Most patients will require a lasix iv minimum cumulative dose of 1 gram of elemental iron, administered over eight sessions at sequential dialysis treatments to achieve favorable hemoglobin or hematocrit response. Lasix iv Pharmacie des HUG Informations sur les médicaments Recommandations d'utilisation des médicaments lasix iv Administration du Lasix iv (furosémide) Lasix i.v. (furosémide) ampoules à 20 mg / 2ml et à 40 mg / 4ml Diurétique antihypertenseur destiné à la voie i.v. ou i.m. Si la voie i.v. est choisie, le Lasix doit être injecté lentement (afin de diminuer les risques d'ototoxicité). Ne pas dépasser une vitesse d'injection de 4 mg/minute Lasix i.v. (furosémide) ampoules à 250 mg / 25 ml (10 mg / ml) Solution pour perfusion destinée aux patients atteints de troubles graves de la fonction rénale. Un tel traitement lasix iv peut être instauré lorsque la dose journalière de 40 mg injectée lentement par voie i.v. n'entraîne lasix iv pas une augmentation de la diurèse. Dans ce cas, il est recommandé de respecter les directives suivantes: n'administrer le Lasix qu'à l'aide d'une seringue avec pousse-seringue. l'ampoule de 250 lasix iv mg de Lasix peut être diluée dans une solution de NaCl 0.9%; ne pas diluer dans une solution de glucose 5%. la dilution est stable 24 h à température ambiante et à lasix iv la lumière du jour. Selon les indications du fabricant, il n'est pas nécessaire de protéger la perfusion de la lumière pendant son administration, à condition qu'elle ne soit lasix iv pas exposée à un éclairage intense. ne pas dépasser la vitesse d'administration de 4 mg/minute(= 0.4 ml/minute) et, en cas d'insuffisance rénale avancée, ne pas dépasser la vitesse d'administration de 2.5 mg/minute lasix iv (= 0.25 ml/minute) (afin de diminuer les risques d'ototoxicité). ne lasix iv pas dépasser une dose journalière lasix iv de 1500 mg. la solution pour perfusion ne doit pas être administrée en association en lasix iv Y avec d'autres médicaments. Stockage des ampoules Les ampoules de Lasix lasix iv se conservent dans leur conditionnement d'origine à l'abri de la lumière. Elles peuvent être utilisées jusqu'à la date imprimée sur l'emballage. AMS-21.04.99 / Mise à jour NA - 23.07.04 © lasix iv 1998-2005 Pharmacie des lasix iv HUG | Webmaster: | Dernière modification de cette page: 28.01.2005 AJN - userLogin LWWOnline | LOGIN | eALERTS | CUSTOMER SUPPORT Home Search Current Issue Archive You are attempting to access protected lasix iv content. To access this content please login using an established account or create/activate an account. Login: subscribers, members & guests If you have already created/ activated an online account, please login below: User Name: Password: Note: passwords are CASE SENSITIVE Activate/Register: new users & guests If you are a new user or guest visiting an LWWonline site for the first time, please complete the new account setup process to view or purchase content. Login Help & Resources Forgot lasix iv your password? Subscribe Renewal Information Copyright © 2005, Lippincott Williams & Wilkins. All rights reserved. Published by Lippincott Williams & Wilkins. 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