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Drug Name Dosages Therapeutic Actions

Indications Adverse effects Contraindications

Nursing considerations

bumetanide (byoo met' a nide) Bumex, Burinex (CAN)

Pregnancy Category C

     Drug class Loop (high-

ceiling) diuretic

Oral edemao Adult: 1 mg

once daily. Give 2nd dose 6-8 hr later if necessary.

o Elderly: 0.5 mg daily.

Refractory edema

o Adult: Initially, 5 mg daily increased by 5 mg every 12-24 hr as required. High doses may be divided in 2-3 doses. Max: 10 mg/day.

hypertension

o Adult: 0.5-1 mg daily. Max: 5 mg/day.

Intravenous pulmonary

edema Adult: 1-2 mg IV

repeated 20 min later if necessary, or 2-5 mg in 500 ml of a suitable infusion fluid

Bumetanide induces diuresis by inhibiting reabsorption of water and electrolytes (sodium and chloride) in the ascending loop of Henle and proximal renal tubule.

Absorption: Almost completely and rapidly absorbed from the GIT.Distribution: 95% bound to plasma proteins.Excretion: Elimination half-life: about 1-2 hr. About 80% excreted in the urine; 50% as unchanged drug.

Edema associated with CHF, cirrhosis, renal disease

IV: Acute pulmonary edema

Unlabeled use: Treatment of adult nocturia (not effective in men with BPH)

Muscle cramps, dizziness, hypotension, headache, nausea, impaired hearing, pruritus, ECG changes, musculoskeletal pain, rash, chest discomfort, renal failure, premature ejaculation, thrombocytopenia, hypokalaemia, hypomagnesaemia, hyponatraemia, hyperuricaemia, hyperglycaemia, hypocalcaemia.

Potentially Fatal: Encephalopathy (in patients with preexisting liver disease).

Hypersensitivity, progressive renal failure and anuria, hepatic coma, severe electrolyte depletion.

Assessment History: Allergy to bumetanide,

electrolyte depletion, anuria, severe renal failure, hepatic coma, SLE, gout, diabetes mellitus, lactation

Physical: Skin color, lesions; edema; orientation, reflexes, hearing; pulses, baseline ECG, BP, orthostatic BP, perfusion; R, pattern, adventitious sounds; liver evaluation, bowel sounds; urinary output patterns; CBC, serum electrolytes (including calcium), blood glucose, LFTs, renal function tests, uric acid, urinalysis

Interventions Give with food or milk to

prevent GI upset. Mark calendars or use

reminders if intermittent therapy is best for treating edema.

Give single dose early in day so increased urination will not disturb sleep.

Avoid IV use if oral use is possible.

BLACK BOX WARNING: Arrange to monitor serum electrolytes, hydration, liver function during long-term therapy, water and electrolyte depletion can occur.

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given over 30-60 min.

Parenteral Emergency cases

of edema Adult: 0.5-1 mg

via slow IV/IM inj, subsequently adjust dose according to response.

Provide diet rich in potassium or supplemental potassium.

Teaching points Record alternate day or

intermittent therapy on a calendar or dated envelopes.

Take the drug early in day so increased urination will not disturb sleep; take with food or meals to prevent GI upset.

Weigh yourself on a regular basis, at the same time and in the same clothing; record the weight on your calendar.

You may experience these side effects: Increased volume and frequency of urination; dizziness, feeling faint on arising, drowsiness (avoid rapid position changes; hazardous activities, such as driving; and alcohol consumption); sensitivity to sunlight (use sunglasses, sunscreen, wear protective clothing); increased thirst (suck sugarless lozenges; use frequent mouth care); loss of body potassium (a potassium-rich diet, or supplement will be needed).

Report weight change of more than 3 pounds in 1 day; swelling in ankles or fingers; unusual bleeding or bruising; nausea, dizziness, trembling, numbness, fatigue; muscle weakness or cramps.

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