Cardiovascular Drugs and Medications Q 42

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Which of the following is a potential side effect of IV furosemide (Lasix)?

  

     A. Drowsiness

     B. Diarrhea

     C. Cystitis

     D. Hearing loss

    

    

Correct Answer: D. Hearing loss

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Patients receiving large doses of loop diuretics are at risk for developing ototoxicity. Ototoxicity can occur with any of the loop diuretics, especially with the concomitant use of aminoglycosides and renal impairment. Furosemide has increased risk for ototoxicity in those with hypoproteinemia (those with nephrotic syndrome). Ethacrynic acid has been known to have a more ototoxic potential than the other members and can lead to permanent sensorineural hearing loss without proper caution of its use, especially concomitantly with another loop diuretic.

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Option A: In those with advanced renal failure with symptoms of fluid overload, physicians should closely monitor fluid status and renal function to prevent the onset of oliguria, BUN, and creatinine increases, and azotemia. Close management of aggressive diuresis requires careful surveillance.

Option B: Diuretic toxicity can present in the form of electrolyte imbalances (hyponatremia, hypokalemia, hypocalcemia), acid/base disturbances (hypochloremic alkalosis), and dehydration secondary to excessive diuresis. Care is necessary to check electrolytes while the patient is on a diuretic periodically.

Option C: Hepatotoxicity or those with cirrhosis also require caution as changes in electrolytes and acid/base balance may precipitate hepatic encephalopathy. An aldosterone antagonist or potassium-sparing diuretic may offer adequate diuresis without the risk of electrolyte imbalance.

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