Details About Generic Salt ::  Bumetani

Main Medicine Class:: Loop diuretic   

(BYOO-MET-uh-nide)
Bumex
Class: Loop diuretic

 

Drugs Class ::

 Action Inhibits reabsorption of sodium and chloride in proximal tubules and loop of Henle.

Indications for Drugs ::

 Indications Treatment of edema associated with CHF, hepatic cirrhosis, and renal disease. Unlabeled use(s): Relief of adult nocturia.

Drug Dose ::

 Route/Dosage

ADULTS: PO 0.5 to 2 mg/day as single dose. If inadequate response, give second or third dose at 4 to 5 hr intervals up to maximum of 10 mg/day. IM/IV 0.5 to 1 mg/day over 1 to 2 min. May repeat at 2- to 3-hr intervals, up to maximum of 10 mg/day. Reserve parenteral route for situations in which GI absorption is impaired or when oral administration is not practical; replace with oral therapy as soon as possible.

Contraindication ::

 Contraindications Hypersensitivity to other loop diuretics or to sulfonylureas; anuria; hepatic coma or states of severe electrolyte depletion until condition is improved or corrected.

Drug Precautions ::

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy not established in children < 18 yr. Dehydration: Excessive diuresis may cause dehydration and decreased blood volume with circulatory collapse and possible vascular thrombosis and embolism, especially in elderly patients. Hepatic cirrhosis and ascites: Sudden alterations of electrolyte balance may precipitate hepatic encephalopathy and coma. Ototoxicity: Associated with rapid injection, very large doses or concurrent use of other ototoxic drugs. Renal impairment: In severe chronic renal insufficiency, patients may benefit from continuous infusion (12 mg over 12 hr) rather than from intermittent bolus therapy. Renal function should be monitored and drug stopped if renal function decreases further. Systemic lupus erythematosus: May be exacerbated or activated.

PATIENT CARE CONSIDERATIONS


Drug Side Effects ::

 Adverse Reactions

CV: Hypotension; ECG changes; chest pain. CNS: Asterixis; encephalopathy with preexisting liver disease; vertigo; headache; dizziness. DERM: Hives; pruritus; itching; nipple tenderness; rash; photosensitivity. EENT: Impaired hearing; ear discomfort; tinnitus; deafness. GI: Upset stomach; dry mouth; nausea; vomiting; diarrhea; pain. GU: Premature ejaculation; difficulty maintaining erection; renal failure. HEMA: Thrombocytopenia; deviations in Hgb, Hct, prothrombin time and WBC, platelets and differential counts. META: Glucosuria and proteinuria; hyperuricemia; gout; hypochloremia; hypokalemia; azotemia; hyponatremia; increased serum creatinine; hyperglycemia; variations in phosphorus, CO2 content, bicarbonate, and calcium; increases in LDL, total cholesterol and triglycerides; decreases in HDL cholesterol. RESP: Hyperventilation OTHER: Musculoskeletal weakness; arthritic pain; pain; muscle cramps; fatigue; dehydration; sweating.

Drug Mode of Action ::  

 Action Inhibits reabsorption of sodium and chloride in proximal tubules and loop of Henle.

Drug Interactions ::

 Interactions

Aminoglycosides: Increased auditory toxicity. Cisplatin: Additive ototoxicity. Digitalis glycosides: Electrolyte disturbances may predispose to digitalis-induced arrhythmias. Lithium: Increased plasma lithium levels and toxicity. NSAIDs: Decreased effects of bumetanide. Salicylates: Impaired diuretic response in patients with cirrhosis and ascites. Thiazide diuretics: Synergistic effects that may result in profound diuresis and serious electrolyte abnormalities.

Drug Assesment ::

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies. Note systemic lupus erythematosus or renal impairment.
  • Ensure that baseline electrolytes have been obtained prior to administration. Do not administer to electrolyte-depleted patients.
  • Check that baseline creatine, BUN, calcium, uric acid and CBC have been obtained before beginning therapy and monitor throughout therapy.
  • Monitor BP and pulse rate frequently.
  • Monitor I&O and daily weight during therapy.
  • Observe for ototoxicity, especially in patients receiving drug via IV infusion and in those taking other ototoxic drugs.
  • Ensure that patient maintains adequate hydration to prevent dehydration.
  • Have epinephrine 1:1000 available if hypersensitivity reaction occurs.
  • If tinnitus, hearing impairment or fullness in ears is reported, notify physician.
OVERDOSAGE: SIGNS & SYMPTOMS
  Profound water loss, volume and electrolyte depletion (characterized by weakness, dizziness, mental confusion, anorexia, lethargy, vomiting, cramps), dehydration, reduction in blood volume, circulatory collapse with possible thrombosis and embolism

Drug Storage/Management ::

 Administration/Storage

  • Give with food or milk to reduce GI upset.
  • Administer by parenteral route only in patients with impaired GI absorption or when oral route is not practical.
  • Drug is most effective when given on alternate days or for 3 to 4 days with rest intervals of 1 to 2 days.
  • If given by IV infusion, use solution within 24 hr of preparation.
  • Store at room temperature in tightly closed container.

Drug Notes ::

 Patient/Family Education

  • Instruct patient to take as single dose early in day. Drug can be taken with food or milk to reduce GI upset.
  • Advise patient to drink adequate fluids to prevent dehydration unless fluid restrictions apply.
  • Caution patient to get out of bed slowly on arising, and to avoid sudden position changes to prevent orthostatic hypotension.
  • If patient is not taking a potassium supplement, advise patient to increase potassium-rich foods in daily diet.
  • Instruct patient to report the following symptoms to physician: Signs of bleeding, weakness, cramps, nausea or dizziness.
  • Caution patient to avoid exposure to sunlight, and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
  • Advise diabetic patients to monitor blood glucose carefully because drug may cause loss of glycemic control.

Disclaimer ::

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