FRUSEMIDE and QUINIDINE

Subject: Basic Science Applied to Nursing

FRUSEMIDE

It prevents luminal membrane transfer of sodium, potassium, and chloride in the ascending limb of the henle loop.
Large volumes of diluted urine are produced as a result of decreased reabsorption of sodium, potassium, and chloride as well as a decreasing osmotic gradient between the cortex and medulla.

To lessen the chance of stomach discomfort, administer with food or milk.
A significant dose of frusemide can cause profound fluid and electrolyte loss, hence fluid and electrolyte levels should be regularly monitored.
In patients with hepatic illness, use with caution.
A slow IV infusion should take 1-2 minutes. Carefully observe patients receiving parenteral medication and keep an eye on their vital signs, particularly their blood pressure.
With Frusemide, potassium supplements should be administered. To prevent potassium depletion, consume foods high in potassium on a daily basis (such as bananas, oranges, etc.).
I&O ratio and pattern monitoring If your output decreases or increases in an odd way, tell your doctor. Dehydration, hypovolemia, hypotension, and circulatory collapse are all effects of excessive diuresis.
During and before treatment, keep an eye on your electrolytes, kidney and liver function, sodium, potassium, calcium, and magnesium levels, BUN, serum glucose, creatinine, and uric acid levels.

It interacts with the sodium channel and blocks it, preventing sodium influx, which slows rapid upstroke and prevents ventricular and ectopic arrhythmias.
In depolarized tissue more so than in normal tissue, it lowers excitability and conduction.

After cardioversion of arterial fibrillation &/or flutter, prophylaxis is used to keep the sinus rhythm normal.
Prevent the recurrence of Plasmodium falciparum malaria, paroxysmal supraventricular tachycardia, paroxysmal A-V junctional rhythm, paroxysmal ventricular tachycardia, proximal arterial fibrillation, and premature atrial or ventricular contractions.

Adult
- Test dose
  - 200 mg given several hours before the recommended dosage.
- Quinidine sulfate
  - 4-6 hours of 100-600 mg
- Quinidine gluconate
  - Tid or qid 324-974mg
- IM
  - 400mg every 4-6 hours.
- IV
  - 200-400mg/dose
Child
- Test dose
  - 2mg/kg
- Quinidine sulfate
  - 6mg/kg/dose given orally every 4–6 hours

Some doctors utilize an oral test dose to identify idiosyncrasies before setting a full dosing plan.
For best absorption, oral medications should be taken with a full glass of water and on an empty stomach.
Dosage forms for sustained release must not be chewed, crushed, or broken. Some quinidine gluconate extended release tablet formulations do not score the tablets.
Deltoid should be used for IM injection. To prevent accidental entrance into a blood vessel, properly aspirate before injecting.
IV Infusion: 800 mg (10 ml) should be diluted with at least 40 ml of D5 to achieve a maximum concentration of 16 mg/ml, and then administered using an infusion pump at a rate not to exceed 16 mg (1 ml)/min. Quinidine may produce severe hypotension and peripheral vascular collapse when infused too quickly.
It could result in impaired vision or vertigo. Do not operate machinery or drive.
Increased solar sensitivity could result from it. Till you know how quinidine sulfate affects you, stay away from the sun, sunlamps, and tanning booths. If you must spend a lot of time outside, wear protective clothing or a sunscreen.
Never stop taking this medication without consulting a doctor.