Pharmacological and Parenteral Therapies Q 95
Nurse Trisha teaches a client with heart failure to take oral furosemide in the morning. The reason for this is to help…
A. Retard rapid drug absorption
B. Excrete excessive fluids accumulated at night
C. Prevents sleep disturbances during night
D. Prevention of electrolyte imbalance
Correct Answer: C. Prevents sleep disturbances during night
When diuretics are taken in the morning, the client will void frequently during daytime and will not need to void frequently at night. Normally, when an individual receives furosemide either orally or intravenously, it increases sodium excretion in urine. In a patient with extracellular volume expansion who has never had exposure to furosemide, the first dose of the drug causes significant sodium excretion and diuresis within the first 3 to 6 hours.
Option A: Furosemide inhibits tubular reabsorption of sodium and chloride in the proximal and distal tubules, as well as in the thick ascending loop of Henle by inhibiting sodium-chloride cotransport system resulting in excessive excretion of water along with sodium, chloride, magnesium, and calcium.
Option B: Excreting excessive fluids at night could cause sleep disturbances for the client. The onset of action of furosemide is usually within the first hour of oral furosemide intake, and it takes first 1 to 2 hours to achieve a peak effect. The mean bioavailability of oral furosemide is 51% compared with the bioavailability of intravenously administered furosemide.
Option D: Administration of furosemide results in excessive excretion of water along with sodium, chloride, magnesium, and calcium. Although more furosemide gets excreted in the urine after IV administration, there is no difference in the amount of unchanged furosemide excretion in urine between the two formulations. Furosemide achieves an early and high serum peak concentration and a higher peak excretion rate after intravenous administration.