This document provides information about the diuretic drug Lasix (furosemide). It defines diuretics as substances that promote urine production by the kidneys. Lasix is classified as a high efficacy diuretic that inhibits sodium-potassium-chloride cotransport. It is indicated to treat edema, hypertension, and congestive heart failure. Nurses are responsible for monitoring patients taking Lasix for side effects like electrolyte disturbances and dehydration. Precautions must be taken with patients who have liver or kidney problems.

1. DRUG STUDY
CREATED BY
BRIJESHTYAGI
M.Sc.(N)PREVIOUS
P. G. COLLEGE OF NURSING
C. H. R. I. GWALIOR

2. DIURETICS

3. DEFINITION
1. A DIURETICS IS ANY SUBSTANCETHAT
PROMOTESTHE PRODUCTIONOF URINE
BY KIDNEY.
2. INCREASINGTHEVOLUME OFTHE URINE
EXCRETED,AS BY A MEDICAL SUBSTANCE.

4. CLASSIFICATION
1. HIGH EFFICACY DIURETICS(inhibitors of Na+-k+-2cl-
contransport)
(a)Sulphamoyl derivatives :-Furosemide, Bumetanide
(b)Phenoxyacetic acid derivatives:-Ethacrynic acid
(c)Organomercurials:-Mersalyl
2. MEDIUM EFFICACY DIURETICS(Iinhibitors of Na+_cl
symport)
(a)Benzathi adiazines(thiazides):-
Clorothiazide,Hydroclorothiazide,Benzathiazide,Hydr
oflumethiazide clopamide.
(b)Thiazidelike(related heterocyclics):-
Metolazone,xipamide,Indapamide.

5. 3. WEAK OR ADJUNCTIVE DIURETICS
(a)Carbonic anhydrase inhibitors:-
Acetazolamide
(b)Potassium sparing diuretics:-
(1)Aldosterone antagonist:- Spironolactone
(2)Directly acting:-Triamterence,Amiloride.
(c)Osmotic diuretics:-Mannitol ,Isorbide,
Glycerol
(c)Xanthines:-Theophylline

6. PHARMACOLOGICAL NAME
 Furosemide

7. TRADE NAME
 Lasix

8. CATEGIRORIES ACCORDING TO
PREGNANCY RISK
Category-C

9. COMPOSITION
 LasixTablets 40mg
Each uncoated tablet contains furosemide
I.P. 40mg
 Lasix injection 2ml
Each ml contains furosemide I.P. 10mg
water for injection I.P. qs

10. ROUTE & DOSE AS PER AGE
 GENERAL:-In adults the recommended maximum daily dose furosemide for
both oral & I/V administration 1500mg
Basic formula
D÷H×V=Amount to give
D=desired dose
H=dose on container label or dose on hand
V=form & amount in which drug comes(tablets, capsule, liquid)
Example:-
Order- Lesix-50mg I/V TID
Drug available- Lasix 125mg /5ml
D=50mg H=125mg V=5ml
50÷125×5=250÷125
=2ML

11.  CHILDREN:-The recommendation dose of furosemide for oral administration is 2mg/kg
body weight ; up to maximum daily dose of 40mg
 The recommendation dose of furosemide for parenteral administration is 1mg/kg body
weight ; up to maximum daily dose of 20mg
Clark’s Rule
Adults dose ×(wt.÷150)=child’s dose
Example:-
11year old girl /70lbs
500mg×(70÷150)=child’s dose
500mg×(.47)=child’s dose
500mg×.47=235mg
child’s dose=235mg
Young’s Rule
Adults dose× (age÷ (age+12))=child’s dose
Example:-
11year old girl /70 lbs
500mg ×(11 ÷(11+12))=child’s dose
500mg×(11÷23)=child’s dose
500mg×.48=child’s dose
child’s dose= 240mg

12. Dosage based on weight
Often drugs are prescribed based on an adults or child’s weight
in order to more accurately dose.The dose calculation is
very simple and easy to perform . However, you must pay
close attention to whether the dosage has been prescribed
per kg or lbs
Example:-
33lbs child is prescribedAcyclovir 5mg/kg
first convert lbs to kg
(33÷2.2)=15
The prescription calls for 5mg per kg
15×5mg=75mg
 ADULTS:-
20 to 80mg daily P.O.
20 to 40mg daily I/V

13. INDICATION
 Edema
 Hypertension
 Hypercalcemia
 Renal calcium stone
 Acute & Chronic congestive cardiac failure
 Pulmonary edema with hypertension

14. CONTRAINDICATION
 Anuria
 Hepatic coma
 Severe electrolyte depletion
 Hypovolemia
 Dehydration
 History of allergic reaction

15. INTRACTION
 DRUG
Amphotericin-b, Neohrotoxic and ototoxic
medications:-may increase the risk of nephrotoxicity
and ototoxicity
Anticoagulants heparin :- may decrease the effects of
the drugs
Lithium:- may increase the risk of lithiumtoxicity.

16. PHARMACOKYNETICS,ABSORPTION,
DISTRIBUTION,HALF LIFE &
EXECRETION
 Well absorbed from the G.I. tract
 Partially metabolized in the liver
 Primarily excretion in urine
half-life
30 to 90 minutes

17. SIDE EFFECTS
 G.I. :- Nausea, Dyspepsia, Abdominal Cramps,
Diarrhea, or Constipation, Electrolyte
Disturbances
 C.N.S. :-Headache, Dizziness, restlessness.
 E.N.T. :-Blurred vision
 I. S. :- Dehydration

18. NURSES RESPONSIBILITY
Baseline Assessment
 Monitor the pt’s vital signs especially
temperature and B. P. before giving furosemide.
 Assess the pt’s baseline electrolyte levels,
particularly for hypokalemia.
 Examine the pt. for edema, and assess mucous
membranes and skin turgor to determine
hydration status.
 Evaluate the pt. mental status and muscle
strength.
 Obtain the pt. baseline weight
 Begin monitoring the pt. fluid intake and out put.

19. PRECAUTION
 Use furosemide cautiosly in pt’s with hepatic cirrhosis
ADMINISTRATION AND HANDLING
P.O. :-Give furosemide with food to avoid G.I. upset ,
preferably with breakfast to help prevent nocturia.
I/V :- (1)The solution normally appears clear & colorless.
Discard yellow solution.
(2)Administer each 40mg or less by I/V push over 1 to 2
minutes. Don’t exceed an administration rate of 4mg/minutes in
pt’s with renal impairment.
I/M :- Monitor the pt. for temporary at the injection site.

20. INTERVENTION AND EVALUATION
 Monitor the pt’s B.P., serum electrolyte level, fluid
intake and output, vital signs and weight
 Monitor the pt. for electrolyte disturbances.
Hypokalemia may result in cardia arrhythmia,
altered mental status, muscle cramp astheria and
tremor.
Lab diagnosis- eg. Na+ ,k etc.

21. PATIENT TEACHING
 Tell the pt. to expect an increase in the frequency
and volume of urination.
 Advise the pt. to notify the physician if he or her
experiences hearing abnormalities or signs of an
electrolyte imbalances.
 Encourage the pt. to eat foods high in potassium,
including apricots, bananas, orange juice, potatoes,
raisins, legumes, meat and whole grains.
 Urge the pt. to avoid overexposure sunlight and
artificial light such as sun lamp.

22. RECORD AND REPORT
 Maintain intake or output chart.
 Maintain body weight chart.
 Maintain B.P. chart.
 Benifit as per indication for when medication given

23. SPECIAL NOTE
 Not given at night, suitable time is before
3pm for better sleep at night.