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Offline Dr.Habiib

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Case (75)
« on: September 08, 2011, 06:42:23 PM »
A 70-year old man is admitted to hospital with history of heart failure and acute left ventricular myocardial infarction, he has severe pulmonary edema. We started a powerful diuretic drug which is useful in treatment of acute pulmonary edema.

1. What is the name of this drug?

2. What is mechanism action of this drug?

3. What are the pharmacological actions of this drug?

4. What are the advantages of this drug over other groups of diuretic drugs?

5. What are therapeutic uses of this drug?

6. What are the adverse effects of this drug?


Ethical principles of medical professionalism:
1. Beneficence: to do good to patient.
2. Non maleficence: not to harm the patient.
3. Justice: to be fair to all patients.
4. Respect for autonomy: free decision for the patient

Offline dr-awale

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Re: Case (75)
« Reply #1 on: September 09, 2011, 08:23:03 PM »
What is the name of this drug?

Furusamide P.O.

What is mechanism action of this drug?

Furosemide, like other loop diuretics, acts by inhibiting NKCC2, the luminal Na-K-2Cl symporter in the thick ascending limb of the loop of Henle.
 
What are the pharmacological actions of this drug?

he action on the distal tubules is independent of any inhibitory effect on carbonic anhydrase or aldosterone; it also abolishes the corticomedullary osmotic gradient and blocks negative as well as positive free water clearance.

What are the advantages of this drug over other groups of diuretic drugs?

the treatment of two conditions: hypertension and edema It is the first line agent in most people with edema due to congestive heart failure

What are the adverse effects of this drug?

it can cause dehydration and electrolyte imbalance, including loss of potassium, calcium, sodium, and magnesium. It is especially important to prevent potassium loss. Excessive use of furosemide will most likely lead to a metabolic alkalosis due to hypochloremia and hypokalemia
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Offline Dr.Habiib

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Re: Case (75)
« Reply #2 on: September 10, 2011, 06:12:18 PM »

Thank you dr-awale   for your answer.
But let me to make more discussion to get our doctors full  informations.

Answers:
1. The name of drug is : Furosemide   powerful loop diuretics.
  NB: some of text book Write. Frusemide.

2. Mechanism action of furosemide:

   Loop diuretics inhibit the co-transport of Na+/K+/2Cl- in the luminal membrane in ascending limb of the Loop of Henle. Thefore, reabsorption of these ions is decreased. The Loop diuretics are the most efficacious of the diuretic drugs, because the ascending limb accounts for reabsorption of 25 to 30 percent of filtered NaCl and downstream sites are not able to compensate for this increased Na+load.

3. Pharmacological action of loop diuretics (Furosemide):

  Act on the ascending loop of Henle leading to:
- ?Excretion of Na and Cl  and  water leading to diuretics.
- ? Excretion of K+  leading to hypokalemia.
- ?Excretion of  Ca+2  leading to hypocalcemia.
- ? Excretion of Mg+2 leading to  hypomagnesemia.
- ? Renal blood flow.
- ? Blood  sugar leading to hyperglycemia.
- ? Uric acid secretion leading to hyperuricemia.

 NB: The symbol (?): means increasing.  And (?): means decreasing.

4. Advantages of loop diuretic (Furosemide) over other diuretics:

a. Loop diuretics e.g ( Furosemide) are most powerful diuretic (high efficacy or high ceiling diuretics).
b. Rapid onset and short duration action.
c. For emergencies we can give I.V.
d. Used in renal faiture as increases renal blood flow.

5. Therapeutics uses of loop diuretic e.g Furosemide are:
a. Emergencies e.g:
- Acute pulmonary edema (acute heart failure).
- Hypertention emergencies.
- Acute renal failure as it increases renal blood flow.
b. Severe hypertention and severe heart failure.
c. Hypertension with renal insufficiency.
d. Hypercalcemia.
e. Refrectory edema due to leading heart failure, nephritic syndrome and liver cirrhosis.


6. Adverse effect of Loop diuretic e.g: Furosemide are the following:


a. Five hypo-

- Hypokalemia.
- Hyponatremia.
- Hypocalcemia.
- Hypomagnesemia.
- Hypotension.

b. Two hyper-
- Hyperuricemia.
- Hyperglycemia.

c. Ototoxicity.
d. Anorexia, nausea,vomiting.


Ethical principles of medical professionalism:
1. Beneficence: to do good to patient.
2. Non maleficence: not to harm the patient.
3. Justice: to be fair to all patients.
4. Respect for autonomy: free decision for the patient

Offline Dr.Adnan

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Re: Case (75)
« Reply #3 on: November 09, 2011, 04:45:13 AM »
I finally understood it....Lippincott pharmacology didn't do it in 2nd year.
**Ruuxaan Dantiisiyo aqoon, waxa daryeelaaya**
**Inuu Deeqda Eebahay ka qaday, dib u xusuusnaada**
Hadraawi...

 

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