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== Background ==
== Background ==
* Mechanism: Inhibits Na-K-2Cl carrier in the '''thick ascending Loop of Henle'''^1^
* Mechanism: Inhibits Na-K-2Cl carrier in the thick ascending Loop of Henle^1^
* Potency: Highest among diuretic classes
* Potency: Highest among diuretic classes
* '''Adverse Effects'''
* Adverse Effects
** Hypokalemia (most common)
** [[Hypokalemia]] (most common)
** Hypomagnesemia, hyponatremia, hypocalcemia
** [[Hypomagnesemia]], [[hyponatremia]], [[hypocalcemia]]
** Ototoxicity (associated with rapid IV push)
** Ototoxicity (associated with rapid IV push)
** Pre-renal [[Acute Kidney Injury|AKI]] (due to over-diuresis)
** Pre-renal [[Acute Kidney Injury|AKI]] (due to over-diuresis)
* '''Sulfa Allergy:''' Most are sulfonamide derivatives; cross-reactivity is rare but possible
* Sulfa Allergy: Most are sulfonamide derivatives; cross-reactivity is rare but possible


== Key Agents ==
== Key Agents ==
* '''[[Furosemide]]''' (Lasix)
* [[Has DrugName::Furosemide]] (Lasix)
** '''Bioavailability:''' Highly variable PO absorption (10-90%, avg ~50%)
** Bioavailability: Highly variable PO absorption (10-90%, avg ~50%)
*** IV dose is approx 2x as potent as PO dose (e.g., 20mg IV ≈ 40mg PO)
*** IV dose is approx 2x as potent as PO dose (e.g., 20mg IV ≈ 40mg PO)
** '''Dosing:''' In [[CHF]], usually start with 1-2.5x the patient's daily home dose IV
** Dosing: In [[CHF]], usually start with 1-2.5x the patient's daily home dose IV


* '''[[Has Diuretic::Bumetanide]]''' (Bumex)
* [[Has DrugName::Bumetanide]] (Bumex)
** '''Potency:''' ~40x more potent than furosemide
** Potency: ~40x more potent than furosemide
*** 1 mg Bumetanide ≈ 40 mg Furosemide
*** 1 mg Bumetanide ≈ 40 mg Furosemide
** '''Bioavailability:''' High and reliable absorption (>80%)
** Bioavailability: High and reliable absorption (>80%)
** Often reserved for patients refractory to furosemide or with severe gut edema
** Often reserved for patients refractory to furosemide or with severe gut edema


* '''[[Has Diuretic::Torsemide]]''' (Demadex)
* [[Has DrugName::Torsemide]] (Demadex)
** '''Kinetics:''' Longer half-life than furosemide
** Kinetics: Longer half-life than furosemide
** '''Bioavailability:''' Excellent oral absorption
** Bioavailability: Excellent oral absorption
*** PO dose is essentially equivalent to IV dose
*** PO dose is essentially equivalent to IV dose
** Less common in acute resuscitation; helpful for chronic management
** Less common in acute resuscitation; helpful for chronic management


* '''[[Has Diuretic::Ethacrynic acid]]''' (Edecrin)
* [[Has DrugName::Ethacrynic acid]] (Edecrin)
** '''Class:''' Phenoxyacetic acid derivative (not a sulfonamide)
** Class: Phenoxyacetic acid derivative (not a sulfonamide)
** '''Indication:''' The only alternative for patients with ''severe'' or anaphylactic '''sulfa allergy'''
** Indication: The only alternative for patients with ''severe'' or anaphylactic sulfa allergy
** '''Toxicity:''' Highest risk of ototoxicity among loop diuretics
** Toxicity: Highest risk of ototoxicity among loop diuretics
** Seldom used as first-line due to side effect profile
** Seldom used as first-line due to side effect profile


Revisión actual - 09:12 22 mar 2026

Background

  • Mechanism: Inhibits Na-K-2Cl carrier in the thick ascending Loop of Henle^1^
  • Potency: Highest among diuretic classes
  • Adverse Effects
  • Sulfa Allergy: Most are sulfonamide derivatives; cross-reactivity is rare but possible

Key Agents

  • Furosemide (Lasix)
    • Bioavailability: Highly variable PO absorption (10-90%, avg ~50%)
      • IV dose is approx 2x as potent as PO dose (e.g., 20mg IV ≈ 40mg PO)
    • Dosing: In CHF, usually start with 1-2.5x the patient's daily home dose IV
  • Bumetanide (Bumex)
    • Potency: ~40x more potent than furosemide
      • 1 mg Bumetanide ≈ 40 mg Furosemide
    • Bioavailability: High and reliable absorption (>80%)
    • Often reserved for patients refractory to furosemide or with severe gut edema
  • Torsemide (Demadex)
    • Kinetics: Longer half-life than furosemide
    • Bioavailability: Excellent oral absorption
      • PO dose is essentially equivalent to IV dose
    • Less common in acute resuscitation; helpful for chronic management
  • Ethacrynic acid (Edecrin)
    • Class: Phenoxyacetic acid derivative (not a sulfonamide)
    • Indication: The only alternative for patients with severe or anaphylactic sulfa allergy
    • Toxicity: Highest risk of ototoxicity among loop diuretics
    • Seldom used as first-line due to side effect profile

See Also

References

Obtenido de «https://www.wikem.org/w/index.php?title=Loop_diuretic&oldid=388997»