. Furosemiade " Lasix "......6. Gentamycin :

******************************************************

5.      Furosemiade " Lasix " :

          Trade names: Apo-Furosemide, Lasix

          Drug class: Loop diuretics

         Pregnancy: (Category C/ D if used in pregnancy-induced hypertension.]

         Therapeutic actions

§         Inhibits the reabsorption of sodium and chloride from the proximal and distal renal tubules and the loop of Henle, leading to a sodium-rich diuresis.

      Indications

·         Edema associated with CHF, cirrhosis, renal disease (oral, IV)

·         Acute pulmonary edema (IV)

·         Hypertension (oral)

Contraindications/cautions

·         Contraindications: allergy to furosemide, sulfonamides; allergy to tartrazine (in oral solution); electrolyte depletion; anuria, severe renal failure; hepatic coma; pregnancy; lactation.

·         Use cautiously with SLE, gout, diabetes mellitus.

          Dose  

§         by mouth, oedema, initially 40 mg in the morning; maintenance 20–40 mg daily, increased in resistant oedema to 80 mg daily or more;

§         CHILD 1–3 mg/kg daily, max. 40 mg daily
 Oliguria, initially 250 mg daily; if necessary larger doses, increasing in steps of 250 mg, may be given every 4–6 hours to a max. Of a single dose of 2 g (rarely used)

§         By intramuscular injection or slow intravenous injection, initially 20–50 mg; CHILD 0.5–1.5 mg/kg to a max. daily dose of 20 mg

§         By intravenous infusion (by syringe pump if necessary), in oliguria, initially 250 mg over 1 hour (rate not exceeding 4 mg/minute), if satisfactory urine output not obtained in the subsequent hour further 500 mg over 2 hours, then if no satisfactory response within subsequent hour, further 1 g over 4 hours, if no response obtained dialysis probably required; effective dose (up to 1 g) can be repeated every 24 hours

Adverse effects

• CNS: Dizziness, vertigo, paresthesias, xanthopsia, weakness, headache, drowsiness, fatigue, blurred vision, tinnitus, irreversible hearing loss
• GI: Nausea, anorexia, vomiting, oral and gastric irritation, constipation, diarrhea, acute pancreatitis, jaundice
• CV: Orthostatic hypotension, volume depletion, cardiac arrhythmias, thrombophlebitis
• Hematologic: Leukopenia, anemia, thrombocytopenia, fluid and electrolyte imbalances
• GU: Polyuria, nocturia, glycosuria, urinary bladder spasm
• Dermatologic: Photosensitivity, rash, pruritus, urticaria, purpura, exfoliative dermatitis, erythema multiforme
• Other: Muscle cramps and muscle spasms

Clinically important interactions

• Drug-drug

• Increased risk of cardiac arrhythmias with digitalis glycosides (due to electrolyte imbalance)
• Increased risk of ototoxicity with aminoglycoside antibiotics, cisplatin
• Decreased absorption of furosemide with phenytoin
• Decreased natriuretic and antihypertensive effects with indomethacin, ibuprofen, other NSAIDs
• Decreased GI absorption with charcoal

    Nursing Considerations

• Administer with food or milk to prevent GI upset.
• Reduce dosage if given with other antihypertensive; readjust dosages gradually as BP responds.
• Give early in the day so that increased urination will not disturb sleep.
• Avoid IV use if oral use is at all possible.
• Do not mix parenteral solution with highly acidic solutions with pH below 3.5.
• Do not expose to light, may discolor tablets or solution; do not use discolored drug or solutions.
• Discard diluted solution after 24 h.
• Refrigerate oral solution.
• Measure and record weight to monitor fluid changes.
• Arrange to monitor serum electrolytes, hydration, and liver function.
• Arrange for potassium-rich diet or supplemental potassium as needed.

*******************************************************

6.      Gentamycin :

Trade name: Garamyein.

Class: - antibiotic, aminoglycoside.

        Pregnancy: (Category C)

Indication:

                     v           It is the drug of choice for hospital- acquired gram negative

      sepsis including neonatal sepsis.

                     v         Serious staphylococcal infections.

Side effects

§          blood pressure, alopecia

§         CNS: ototoxicity, tinnitus, dizziness, ringing in the ears, vertigo.

§         GI: nausea, vomiting, anorexia, weight loss, increased salivation.

§         C.V.: palpitation, hypotension or hypertension.

§         Hematologic: Decrease number of blood cells.

§         GU: nephrotoxicity

§         Local: Pain and irritation at IM injection site.

Formulation:-

Vial 2 ml containing 20 mg.

Ampoule 2 ml containing 80 mg.

Dosage:-

                v               I.M. (usual). I.V. adults 3 mg\kg q 8 hr up to 5 mg\kg daily.

Children 2-2.5 mg\kg q 8 hr.

Newborns 2.5 mg\ kg q 12 hr.

Ophthalmic solution 0.3%, 1-2 drops q 15-30 minutes.

Topical ointment 0.1%, 1-5 times daily to the affected area.

Streptococcal or enterococcal endocarditis in combination with other drugs, 80 mg twice daily.

N.B.:-

 Should not be mixed with other drugs for parenteral use.

Nursing implication:

§         When given IM, give it slowly and deep in the muscle.

§         Dilute dose when given IV.

§         Monitor for kidney function tests, complete blood count when used for more than 7 days. Consult with Dr. accordingly.

*******************************************************