Medication Card – Furosemide (Lasix®) (Kor/Eng)

 

Classification (분류)

• Therapeutic (치료적 분류): Diuretic (이뇨제)
• Pharmacologic (약리학적 분류): Loop diuretic (루프 이뇨제)

 

 

 

Indications (적응증)

• Edema due to CHF, liver cirrhosis, renal disease (심부전·간경변·신질환 관련 부종)
• Hypertension (고혈압)
• Pulmonary edema (폐부종)

 

 

Therapeutic Effects (치료 효과)

• Rapid diuresis → ↓ edema, ↓ blood pressure (빠른 이뇨 → 부종 감소, 혈압 감소)
• Symptom relief in heart failure (심부전 증상 완화)

 

 

 

 

Absorption (흡수)

• Oral: ~60–70% absorbed (경구: 약 60–70% 흡수)
• IV: rapid, more predictable (정맥투여: 빠르고 예측 가능)

 

 

 

Distribution (분포)

• Widely distributed, crosses placenta, enters breast milk (광범위 분포, 태반 통과, 모유 분비)

 

 

 

 

Protein Binding (단백결합)

• ~95% (약 95%)

 

 

 

 

Metabolism & Excretion (대사 및 배설)

• Minimally metabolized (대사 거의 없음)
• Excreted mainly unchanged in urine (주로 신장에서 원형 배설)

 

 

 

 

 

Onset/Peak/Duration (작용발현/최고효과/지속시간)

• PO: Onset 30–60 min / Peak 1–2 hr / Duration 6–8 hr
• IV: Onset 5 min / Peak 30 min / Duration 2 hr
  (경구: 30–60분 / 최고 1–2시간 / 지속 6–8시간, 정맥투여: 5분 / 최고 30분 / 지속 2시간)

 

 

 

 

 

 

Adverse Effects (부작용, ADEs)

• CV (심혈관): Hypotension, orthostatic hypotension (저혈압, 기립성 저혈압)
• Electrolytes (전해질): Hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia (저칼륨, 저나트륨, 저칼슘, 저마그네슘혈증)
• Renal: Dehydration, ↑ BUN/creatinine (탈수, BUN/크레아티닌 상승)
• Ototoxicity: Hearing loss, tinnitus with high IV doses (고용량 IV 시 난청, 이명)

 

 

 

 

 

Drug Interactions (약물 상호작용)

• Digoxin: ↑ toxicity risk if hypokalemia present (저칼륨혈증 시 digoxin 독성 위험 ↑)
• Lithium: ↑ risk of lithium toxicity (리튬 독성 위험 ↑)
• NSAIDs: May ↓ diuretic effect (NSAIDs → 이뇨 효과 감소)
• Other antihypertensives: Additive hypotension (다른 항고혈압제와 병용 시 저혈압 위험 ↑)

 

 

 

 

 

 

Dose (용량)

• Edema (부종): 20–80 mg PO once daily, may increase q6–8h; up to 600 mg/day
• Hypertension (고혈압): 40 mg PO twice daily
• IV: 20–40 mg, may repeat in 1–2 hr, max 600 mg/day

(신장 기능 저하 시 용량 조절 필요)

 

 

 

 

 

 

Nursing Interventions (간호중재)

• Monitor I&O, weight daily (섭취·배설, 체중 매일 확인)
• Monitor BP, electrolytes (K, Na, Mg, Ca), renal function (혈압, 전해질, 신기능 확인)
• Assess for hearing changes with high IV doses (IV 고용량 시 청력 변화 확인)
• Watch for dehydration signs (갈증, 피부 건조, 어지러움)

 

 

 

 

 

Patient Teaching (환자 교육)

• Take in the morning to avoid nocturia (아침에 복용 → 야간뇨 예방)
• Report dizziness, muscle cramps, or hearing changes (어지러움, 근육경련, 청력 변화 시 보고)
• Eat potassium-rich foods (바나나, 오렌지 등 고칼륨 음식 섭취 권장) unless contraindicated (금기 없을 시)
• Rise slowly to prevent dizziness (기립성 저혈압 예방 위해 천천히 일어나기)
• Weigh yourself daily; report weight gain >2 lb (1kg) in 24 hr (매일 체중 측정, 하루 1kg 이상 증가 시 보고)

 

 

Furosemide (Lasix) 

diuretics/loop diuretics 

● Indications: edema due to HF, hepatic impairment, or renal disease. HTN 

● Therapeutic effects: diuresis and subsequent mobilization of excess fluid (edema, pleural effusions), Decrease BP ● Absorption: 60-67% after PO, IM sites 

● Distribution: cross placenta, enter breast milk 

● Protein binding: 91-99% 

● Metabolism&Excretion: by liver, some non hepatic and renal excretion 

● ADE: Derm; erythema multiforme, stevens-johnson syndrome, toxic epidermal, necrolysis F and E; dehydration, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis Hemat; aplastic anemia, agranulocytosis 

● Dose: PO; 20-80 mg/day as a single dose initially > may repeat in 6-8hr, may up by 20-40 mg every 6-8hr until desired response. Maintenance doses may be given daily or BID, 

 

 

 

 

CMANIA PHARAMCOLOGY FRAMEWORK

Generic Drug Name: furosemide	Common TRADE names: Lasix, Furoscix
Classification: category, Body System affected	Diuretic, loop diuretics (Kidneys). Urinary system affected.
Movement: Pharmacokinetics (absorption, distribution, metabolism, excretion) half- Life	60-67% absorbed after oral administration (lower in acute heart failure and in renal failure); also absorbed IM. Crosses the placenta, enters breast milk. Protein binding: 91-99%. Metabolized minimally by liver, some nonhepatic metabolism, some renal secretion as unchanged drug. Half-life: 30-60 min. (higher with renal impairment). Onset: PO: 30-60min., IM: 10-30min., IV: 5min. Peak: PO: 1-2hr, IM: unknown, IV: 30min., Duration: PO: 6-8hr, IM: 4-8hr, IV: 2hr.
Action: Pharmacodynamics (mechanism of action, lifespan and health challenge considerations (Nursing Considerations) Therapeutic Effects	Inhibits reabsorption of sodium and chloride from the loop of Henle and distal renal tubule. Increases renal excretion of water, sodium, chloride, magnesium, potassium, and calcium. Still effective in renal impairment. Lifespan considerations: pediatrics, geriatrics (appears on Beers list). Therapeutic Effects: Diuresis and mobilize excess fluid. Decreased BP.
Nursing Considerations: Safety: contraindications, interactions, side effects, adverse reactions, special population monitoring.	Contraindications: hypersensitivity; potential cross-sensitivity with thiazides and sulfonamides; hepatic coma or anuria; liquid products may contain alcohol, avoid in PT with intolerance. Adverse Reactions/Side Effects: Derm: ERYTHEMA MULTIFORME, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, photosensitivity, pruritis, rash, urticaria. Hemat: APLASTIC ANEMIA, AGRANULOCYTOSIS, hemolytic anemia, leukopenia, thrombocytopenia. F&E: dehydration, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis. CNS: blurred vision, dizziness, headache, vertigo. CV: hypotension. EENT: hearing loss, tinnitus. ENDO: hypercholesterolemia, hyperglycemia, hypertriglyceridemia, hyperuricemia. GI: anorexia, constipation, diarrhea, dry mouth, dyspepsia, increased liver enzymes, nausea, pancreatitis, vomiting. GU: increased BUN, excessive urination, nephrocalcinosis. MS: muscle cramps. Neuro: paresthesia. Misc: fever. Use cautiously: Severe liver disease, Electrolyte depletion, Diabetes mellitus, Hypoproteinemia, Severe renal impairment, lactating. Drug-Drug: risk of: hypotension (antihypertensives, nitrates, alcohol consumption); hypokalemia (diuretics, amphotericin B, stimulant laxatives, corticosteroids); digoxin toxicity; lithium toxicity; ototoxicity (aminoglycosides, cisplatin); nephrotoxicity (cisplatin); reduced effects (NSAIDS, sucralfate, cholestyramine, colestipol); methotrexate toxicity; salicylate toxicity; gouty arthritis (cyclosporine).
Indications: Pharmacotherapeutics/Safe Dose/Range toxicity?	Edema due to heart failure, hepatic impairment, or renal disease. Hypertension. High therapeutic index.  Max. dose: IM/IV (Adult): 100mg/day, 4mg/min. (IV). PO (Adult): 200mg/day. PO (Children): 6mg/kg.
Administration: Doses, routes, special instructions, Medication administration guidelines: BCCNM 10 Rights	Dosage: Edema: PO (Adults): 20-80mg/day as single dose initially, may repeat in 6-8hr. IM, IV (Adults): 20-40mg, may repeat in 1-2hr. See drug guide for children, neonates treatment. Hypertension: PO (Adults): 40mg BID. See drug guide for IV administration and Y-site compatibility.  10 rights: Right Patient, Right Dose, Right Medication, Right Route, Right Time, Right Education, Right to Refuse, Right Assessment, Right Evaluation, Right Documentation. Confirm x3

Nursing Assessment: Medication:

Medical Conditions the Medication is used for: Hypertension. Edema due to heart failure, hepatic impairment, or renal disease.  Perform head to toe assessment Subjective Data Collection: Hx of Tinnitus/hearing loss Daily voiding frequency and bowel habits Regular daily fluid intake Sleep routine (regular bedtime) Abdominal pain/hx of dyspepsia Alcohol use and frequency Hx of swelling in the extremities Current pregnancy Current lactation   Objective Data Collection: Monitor fluid input and output  Monitor BP and pulse before and during administration Current medications (uses, frequency, dosages) Allergy to sulfonamides Complete lab tests prior to and throughout therapy: electrolytes, renal and hepatic function, serum glucose, uric acid level.  Daily weight tracking Assess lung sounds, edema, skin turgor, mucous membranes Pregnancy test if suspected pregnancy Fall risk

Patient Education Client Teaching

Instructions: Explain purpose and side effects of furosemide. Take as directed. Take missed dose ASAP; do not double doses. Give/take dose no later than 5pm to minimize sleep disruption. PO: take with food or milk to minimize GI irritation; tablet may be crushed, if needed. Minimize Orthostatic hypotension by; slow position changes, avoid use of alcohol, avoid exercise during hot weather, avoid standing for long periods. Use sunscreen. Refer to appropriate healthcare professional for education on high potassium diet. Potassium supplements/potassium-sparing diuretics may be used concurrently to prevent hypokalemia. Immediately report any signs of rash, muscle weakness, cramps, nausea, dizziness, numbness, or tingling of extremities, hearing loss, sudden weight gain, excessive thirst, lethargy. Notify healthcare professional before surgery or treatments. Notify healthcare professional if pregnancy is planned or suspected, or if breast feeding. Geri: increased risk for falls. Provide fall prevention strategies. Diabetic pt: monitor blood glucose closely; furosemide may increase blood glucose levels.