Frusemide: Mechanism of Action, Side Effects and Contraindications

Running head: FRUSEMIDE
FRUSEMIDE
Name of the Student
Name of the University
Author Note

1
FRUSEMIDE
Part B
Answer 1
Oedema is a pathological condition which is characterised by fluid build up in the
body resulting in the swelling of the tissue. Although oedema can affect any part of the boy,
the major effect is noticed over hands, arms, feet, legs and ankles. Congestive heart failure is
one of the principal causes of oedema under clinical practice. In congestive heart failure,
oedema results from the activation of the series of neuro-humoral and humoral mechanisms
that causes water and sodium reabsorption by the kidneys and subsequent expansion of the
extra-cellular fluid. These pathological mechanisms work in concert with abnormal starling
forces like increase in venous capillary pressure and decrease in plasma oncotic pressure. All
these lead to fluid extravasation and formation of oedema (Yancy et al., 2016).
Yancy et al. (2016) highlighted that in case of congestive heart failure, either one or
both the lower chamber of the heart lose their ability to pump adequate blood throughput the
body. As a result, the permissible level of blood fail to reach to the far extremities of the body
like leg, finger tips, ankles or arm and thereby causing fluid build up. It the condition is not
treated on time, the fluid build up may increase considerable, reaching up to the lungs
(pulmonary oedema).
Answer 2
Frusemide chemical name is benzoic-sulfonamide-furan. It is diuretic in nature having
fast onset with short half-life and used for the treatment of oedema and chronic renal failure.
Frusemide is a loop diuretic that prevents water reabsorption within the nephron via blocking
the sodium-potassium-chloride co-transporter (NKCC2) within the thick ascending limb of
Henle’s loop. This is done via competitive inhibition at the chloride-binding site of the co-
transporter and thereby preventing the transport of the sodium from the lumen of Henle’s
loop into the basolateral interstitum. Consequently, the lumen becomes hypertonic in
comparison to interstitium. This disrupts the osmotic balance required for reabsorption
throughout the nephron. Decrease in the reabsorption in the ascending limb of the lumen
decreases water retention and thereby helping to control blood vessel congestion (Marenzi, et
al., 2012).

2
FRUSEMIDE
Answer 3 (i)
Hyponatremia is a fatal condition in diuretic therapy. It is characterised by electrolyte
imbalance were serum concentration of sodium falls below the normal range. The symptom
of hyponatremia is mainly surfaced within 1 to 2-weeks of initiation of the therapy by
Frusemide. However, the condition of hyponatremia is rate in case of loop diuretic in
comparison to the thiazide diuretic. The main reason behind the appearance of hyponatremia
is imbalance between Frusemide and fluid intake. This imbalance leads to over-excretion of
sodium through the kidneys leading to electrolyte imbalance and thereby causing
hyponatremia (Verbalis et al., 2013).
The associated effects of hyponatremia include acute neurological impairment due to
fall in the serum level of sodium. Decrease in the sodium content in body hampers the proper
functioning of the sodium-potassium channel thereby hampering the neurotransmission and
hampering neurological functions. Other associated effects include nausea, vomiting,
restlessness, muscle cramps, disorientation and depressed reflexes (Verbalis et al., 2013).
Answer 3 (ii)
Orthostatic hypotension is defined as postural hypotension and is a defined a
pathological condition characterized by low blood pressure which surfaces when a person is
standing up from a sitting position of lying down suddenly from sitting position. The
associated side effects of mild to moderate orthostatic hypotension are feeling dizzy or light-
headed or may be fainting. Long-lasting orthostatic hypotension is fatal. The main reason
behind the occurrence of orthostatic hypotension is dehydration or prolongs bed-rest. Prolong
use of diuretic medication lead to dehydration due to more excretion of urine high in sodium
content. This lack of reabsorption of sodium causes electrolyte imbalance and excretion of
more water from the body causes dehydration which together leads to orthostatic hypotension
(Gibbons et al., 2017).
Answer 4 (i)
Frusemide is not recommended along with Amiodarone as combination of these two
medications increase the risk of irregular heart rhythm that at times can be fatal. Amiodarone
cast antiarrhythmic effect and this increases the myocardial cell-action potential (phase: 3)
duration along with the refractory period of the action potential via acting as the non-
competitive inhibitor of the alpha and beta adrenergic receptor. However, under the influence
of the Frusemide, the sodium ion concentration within the body gets hampered along with a