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Loop Diuretics

Loop-Hen Die-Rocket
Picmonic

Loop diuretics are a class of diuretics that inhibit the NaK2Cl symporter in the thick ascending limb of the loop of Henle. Furosemide is the generic name for one of the most commonly used loop diuretic and has the trade name of Lasix. These drugs are sulfa drugs as they contain a sulfonamide group and can cause an allergic reaction in patients with a sulfa allergy. Loop diuretics often also lead to hypokalemia and hypocalcemia and can reduce the urate excretion leading to hyperuricemia and gout. Ototixicity is also a serious but rare adverse effect of loop diuretics.

11 KEY FACTS
MECHANISM OF ACTION
Thick ascending limb of Loop of Henle
Thick Ascending Limb of the Loop of Henle

Loop diuretics act on the Na+ ,K+, 2Cl- symporter in the thick ascending limb of the loop of Henle. The medullary thick ascending limb is mostly impermeable to water.

Inhibits Na+-K+-2Cl-
Inhibiting-chains on Salt-shaker, Banana, and Chlorine-dispenser in (2) Tutu

Loop diuretics act on the Na+ ,K+, 2Cl- transporter in the thick ascending limb of the loop of Henle. They inhibit sodium and chloride reabsorption by competing for the Cl- binding site. Loop diuretics prevent the generation of a hypertonic renal medulla which prevents urine from being concentrated and leads to increased urine production.

Sulfa drug
Sulfur-match

Furosemide (Lasix) contains a sulfonamide group and can cause an allergic reaction in patients with a sulfa allergy.
Patients with hypersensitivies to sulfa drugs may be prescribed ethacrynic acid (Edecrin) which is a loop diruetic without a sulfer component. Ethacrynic acid should be remembered because it has a greater risk of ototoxicity compared to Furosemide.

DRUG NAMES
Furosemide
Fur-rose

Furosemide is the generic name for a commonly prescribed potent loop diuretic. Other loop diruetics include torsemide (Diuver), bumetanide (Bumex), and ethacrynic acid (Edecrin). 

Lasix
Laser

Lasix is the brand name of Furosemide and is one of the most commonly used loop diuretics.

SIDE EFFECTS
Ototoxicity from Rapid Injection
Ears with a Toxic-green-glow from Fast Syringe

Ototoxicity (damage to the ear) is a serious but rare adverse effect of loop diuretics. Symptoms may be limited to tinnitus and vertigo but serious cases can result in hearing loss.

Gout
Gout-goat

High levels of uric acid in the blood is the underlying cause of gout. This can occur for a number of reasons including diet, medications, genetics, or underexcretion of urate from the kidneys. Diuretics have been associated with hyperuricemia and gout.

Dehydration
Empty-canteen

Excessive use of diuretics may cause hypovolemia which may manifest as dehydration with skin tenting and excessive thirst and also low blood pressure.

Hypocalcemia
Hippo-calcified-cow

Inhibition of the Na+, K+, 2Cl transporter causes a failure of reabsorption of calcium which may cause hypocalcemia. Hypocalcemia may manifest as ECG changes, muscle spasms, or tetany. Remember Chvostek sign and Trousseau's sign are indicators of hypocalcemia.

Hypokalemia
Hippo-banana

Because loop diuretics prevent reabsorption of sodium and chloride ions in the loop of Henle, there is an increased amount of sodium and water that passes through the collecting tubules. This causes a reflex secretion of potassium into the urine by increased aldosterone secretion. Also, volume depletion due to increased urine output causes increased secretion of aldosterone which further increases the secretion of potassium into the collecting duct and into the urine, leading to hypokalemia.

Hypokalemia may manifest as ECG changes, muscle tingling or weakness, fatigue and constipation. 

Orthostatic Hypotension
Oar Hippo-BP

Orthostatic hypotension occurs when a person’s blood pressure suddenly falls when standing up or stretching. Educate the patient to rise slowly or dangle their feet off the bed before standing.

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