183 - The Ultimate Guide to Loop Diuretics: An In-Depth Drug Class Review

HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast

Sean P. Kane, PharmD, BCPS

Health & Fitness, Medications, Rosalindfranklin, Rfums, Pharmacy, Pharmd, Pharmacist, Medicine, Drugs

5 • 644 Ratings

🗓️ 28 June 2024

⏱️ 36 minutes

🔗️ Recording | iTunes | RSS

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Summary

In this episode, we review the pharmacology, pharmacokinetics, adverse effects, monitoring, medicinal chemistry, and more of loop diuretics.

Key Concepts

Loop diuretics (furosemide, torsemide, bumetanide, ethacrynic acid) are the most potent type of diuretic and are used to relieve edema.
Loop diuretics cause an increased loss of sodium, chloride, potassium, hydrogen, magnesium, and calcium ions into the urine. Excessive loss of these ions manifests as hypokalemia, hypomagnesemia, and metabolic alkalosis.
Loop diuretics have an S-shaped dose response curve – a minimum dose is required for diuresis and a “ceiling” effect occurs at higher doses (leading to more ADRs). Doses should be individualized based on the clinical response of the patient.
Ethacrynic acid is incorrectly used in patients with a “sulfa” allergy. The other loop diuretics contain a sulfa moiety but are safe for use in patients with “sulfa” allergy (e.g. allergy to sulfamethoxazole-trimethoprim).
The TRANSFORM-HF trial strongly suggests that there is no clinical difference between furosemide and torsemide.

References

Rachoin JS, Cerceo EA. Four nephrology myths debunked. J Hosp Med. 2011;6(5):E1-E5. doi:10.1002/jhm.703
Strom BL, Schinnar R, Apter AJ, et al. Absence of cross-reactivity between sulfonamide antibiotics and sulfonamide nonantibiotics. N Engl J Med. 2003;349(17):1628-1635. doi:10.1056/NEJMoa022963
Buggey J, Mentz RJ, Pitt B, et al. A reappraisal of loop diuretic choice in heart failure patients. Am Heart J. 2015;169(3):323-333. doi:10.1016/j.ahj.2014.12.009
Mentz RJ, Anstrom KJ, Eisenstein EL, et al. Effect of Torsemide vs Furosemide After Discharge on All-Cause Mortality in Patients Hospitalized With Heart Failure: The TRANSFORM-HF Randomized Clinical Trial. JAMA. 2023;329(3):214-223. doi:10.1001/jama.2022.23924

Transcript

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0:00.0	Welcome to Helix Talk, an educational podcast for healthcare students and providers covering real-life clinical pearls, professional pharmacy topics, and drug therapy discussions.
0:11.0	This podcast is provided by pharmacists and faculty members at Rosal Franklin University College of Pharmacy.
0:17.0	This podcast contains general information for educational purposes only. This is not professional
0:22.4	advice and should not be used in lieu of obtaining advice from a qualified health care provider.
0:27.2	And now on to the show.
0:31.0	Welcome to Helix Talk, episode 183. I'm your co-host, Dr. Kane. And I'm Dr. Patel.
0:37.1	In this episode is titled, The Ultimate Guide to Loop Diuretics, an in-depth drug class review. So obviously today, Dr. Patel, we're talking about our loop diuretic drug class, everything from the pharmacology to the medicinal chemistry to the pharmacotherapy and everything in between. All right. Well, let's get on the loop and I'm excited.
0:55.4	So obviously we have to start by talking about what are the drugs that count as a loop
0:59.8	diuretic. And by far the most common one is called furosomide or Lasix. But there's a couple other
1:05.3	ones out there as well. Yeah, those are bumatign brand name is Bumax or torsomide brand name is Demodex.
1:12.8	And then not as common as these three.
1:15.6	We have ethycronic acid.
1:17.8	The brand name is attocrine.
1:19.3	And obviously this one is not as common.
1:21.2	We're going to talk about that more in detail later.
1:24.8	And all of these are going to be indicated for the treatment of edema.
1:28.6	Usually this is for peripheral edema, so swelling of the feet and ankles, but also for pulmonary
1:34.4	edema. So fluid in the lungs would be typical for heart failure patients. We can also see it
1:39.6	in cirrhosis or chronic kidney disease patients. And at the end of the day, these drugs work by making you
1:45.0	pee out water so that you get rid of the water that is kind of accumulating in these different
1:50.4	areas of your body. And in this episode, we're particularly talking about loop diuretics,
1:55.6	but there are other diuretics out there, Dr. Kane. So how, in particular, the loop diuretics differ from the other ones? Yeah. So those other diuretics out there, Dr. Kane, so how in particular the loop diuretics differ from the other ones?
	...

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