Topic 5 DQ 1
Sample DQ response:
To ensure you answer all aspect of the DQ posts I request that you set your responses up with headings signifying each aspect of the prompt. Here is a sample of what I mean, points will be deducted for not answering all aspects of the DQ. Ethacrynic Acid (Edecrin):Loop Diuretic (PDR, 2021). Mechanism of action:Ethacrynic acid primarily acts to inhibit the reabsorption of sodium and chloride in the ascending limb of the loop of Henle (PDR, 2021). Monitoring:Cr at baseline; BUN/Cr, serum CO2, electrolytes frequently early in treatment then periodically during active diuresis, cardiac monitoring, weight gain or loss, vital signs (Epocrates, 2021). Side Effects:Hypotension, hypovolemia, orthostatic hypotension, sympathectomy, syncope, acid/base imbalance, dehydration, electrolyte imbalance, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia, metabolic alkalosis. Greater risk of ototoxicity when compared to other loop diuretics (Epocrates, 2021).
Severe Adverse Reactions:Agranulocytosis, pancreatitis hearing loss, GI bleeding, azotemia, oliguria (PDR, 2021).CAM Interactions:Dong quai, licorice, magnesium, potassium, St. John’s wort, vitamin B1 (EBSCO, 2019). Positive or Negative experience with Ethacrynic acid:This author has not yet had any experience with Ethacrynic acid specifically but has had experiences with patients not taking other loop diuretics such as their Furosemide especially when traveling as they did not want to constantly have to stop to urinate; because of this inconvenience patients would have an exacerbation of their congestive heart failure and present to the emergency department most commonly with chest pain, shortness of breath, or painful extremity swelling. Patients that were placed on diuretics, especially IV diuretics were made fall risk patients due to potential hypotension, electrolyte imbalance, IV lines, and risk of getting out of bed without assistance. Evidence and Treatment Guidelines: 64 y/o African American woman, no comorbid issues. Loop diuretics should be avoided when less efficacious diuretics (thiazides) will suffice.
Conditions that justify the use of loop diuretics such as furosemide include:(1) pulmonary edema associated with congestive heart failure (CHF)(2) edema of hepatic, cardiac, or renal origin that has been unresponsive to less efficacious diuretics; and(3) hypertension that cannot be controlled with other diuretics. Furosemide is especially useful in patients with severe renal impairment because, unlike the thiazides.This drug class can promote diuresis even when renal blood flow and glomerular filtration rate (GFR) are low.
If treatment with loop diuretics alone is insufficient, a thiazide diuretic may be added to the regimen. There is no benefit to combining furosemide with another loop diuretic (Rosenthal & Burchum, 2021). Geriatric patients: According to the Beers Criteria, diuretics are considered potentially inappropriate medications (PIMs) in geriatric patients and should be used with caution due to the potential for causing or exacerbating SIADH or hyponatremia. Sodium levels should be closely monitored when starting or changing dosages of diuretics in older adults (PDR, 2021).African American race is associated with significantly greater systolic BP (SBP) and/or diastolic BP (DBP) responses to thiazide and loop diuretics compared to European-American patients in small studies (Fuentes et al., 2013). EBSCO CAM Review Board. (2019). Loop diuretics (drug interactions). Salem Press Encyclopedia of Health.Ethacrynic Acid. (2021, June). https://online.epocrates.com/drugs/67901/Edecrin/Adult-Dosing