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From available data, ototoxity Post Date: Tue, 14 Oct 2008 19:26:17 +0000 Drug-induced changes in the electrolyte composition of the endolymph represent a possible mechanism. Due to the rarity of this complication, it is not possible to evaluate the contention that it is more common in the presence of renal insufficiency or that it occurs more commonly with one agent than with another. From available data, ototoxity from diuretics is unique to this class of drugs. Autor of the post: Undefined Ethacrynic Acid, USP (EDECRIN) Post Date: Tue, 14 Oct 2008 19:11:07 +0000 If a potentially ototoxic antibiotic, such as an aminoglycoside, is being prescribed and concurrent diuretic therapy is indicated, it is advisable to use other diuretic agents such as thiazides or mercurials.Preparations. Ethacrynic Acid, USP (EDECRIN), is available for oral use as 25- and 50-mg tablets. Autor of the post: Undefined The sodium salt of ethacrymc Post Date: Tue, 14 Oct 2008 18:53:44 +0000 The usual dose for adults is from 50 to 200 mg per day. The optimal dose should be determined for each patient, starting with minimal amounts. The sodium salt of ethacrymc acid is available for intra-venous use as Ethacrynate Sodium for Injection, USP (EDECRIN SODIUM); the usual dose is 50 mg. Autor of the post: Undefined A preparation is also available Post Date: Tue, 14 Oct 2008 18:37:51 +0000 Furose-mide, USP (LASIX), is available as 20- and 40-mg tablets. In adults, the range of optimal dosage varies from 40 to 200 mg per day. A preparation is also available for parenteral administration, either intra-venously or intramuscularly, in ampuls containing 20 mg/2 ml or 100 mg/10 ml of saline solution. Autor of the post: Undefined The high-ceiling diuretics are effective Post Date: Tue, 14 Oct 2008 18:23:51 +0000 The recommended adult dose by this route is 20 or 40 mg, repeated if necessary after not less than 2 hours.Therapeutic Uses. The high-ceiling diuretics are effective for the treatment of edema of cardiac, hepatic, or renal origin. Autor of the post: Undefined In this condition the rapid Post Date: Tue, 14 Oct 2008 18:09:27 +0000 The oral route should be used unless impractical or the clinical situation de-mands a very prompt diuresis, in which case intrave-nous or intramuscular administration may be em-ployed. This applies particularly to the management of acute pulmonary edema. In this condition the rapid reduction of the volume of extracellular fluid is of sufficient magnitude to reduce venous return and right ventricular output. Autor of the post: Undefined By conventional measurements, renal function Post Date: Tue, 14 Oct 2008 17:56:21 +0000 In the management of refractory edema, the high-ceiling agents may be used in conjunction with other types of diuretics, particularly the potassium-sparing drugs, but there is no rationale for administering two high-ceiling agents concomitantly.In the presence of nephrosis or chronic renal fail-ure, doses far higher than usual may be required (Muth, 1973). By conventional measurements, renal function is not compromised by high doses. Autor of the post: Undefined Although case reports suggest Post Date: Tue, 14 Oct 2008 17:36:49 +0000 How-ever, the incidence of undesirable side reactions may be increased (Allison and Kennedy, 1971). Etha-crynic acid and furosemide have been used in acute renal failure. Although case reports suggest the pos-sibility that the maintenance of urine flow may pre-vent further renal damage (Stahl and Stone, 1970), caution is urged in the absence of a better under-standing of basic mechanisms. Autor of the post: Undefined In symptomatic hypercalcemia the high-ceiling Post Date: Tue, 14 Oct 2008 17:25:33 +0000 There are increasing instances of renal insufficiency in which the use of multiple drugs, including diuretics, is suspected but not proven as a causative factor. In the case of cephaloridine-induced renal tubular necrosis, high-ceiling diuretics significantly increased renal damage in a controlled experiment (Dodds and Foord, 1970). In symptomatic hypercalcemia the high-ceiling diu-retics may lower the plasma calcium concentration by increasing the renal excretion of calcium. Autor of the post: Undefined With greater insight into Post Date: Tue, 14 Oct 2008 17:09:23 +0000 This requires the replacement of urinary losses of sodium chloride and water (Suki et al, 1970).ALDOSTERONE ANTAGONISTSThe role of adrenocortical steroids in the regulation of electrolyte and water balance is discussed in Chapter 70. With greater insight into the chemistry of the steroids and with more complete knowledge of their physiological function, it has been possibleto synthesize competitive antagonists that are useful as diuretics. 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