Diuretics in HTN/Pulmonary edema - USMLE Forums
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Old 10-02-2012
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Drug Diuretics in HTN/Pulmonary edema

A 69yr old man comes to the hospital with progressive worsening shortness of breath over the last four days. He has a hx of CHF & his last ECG one yr ago showed a left ventricular ejection fraction of 25%. His BP is 143/74mmHg, HR is 78bpm & pulse oximetry shows 95% oxygen saturation on room air. CXR shows bilateral pulmonary edema. He says he was given hydrochlorothiazide for his BP but stopped taking it after he developed a pruritic rash over both his arms.

What is the best medication to reduce the pxts pulmonary edema?

A. Acetazolamide
B. Mannitol
C. Furosemide
E. Ethacrynic acid
F. Lisinopril
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Old 10-02-2012
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Default My answer E

bilateral pulmonary edema , treatmetn w/ diuretics , mmm the only posible is Ethacrynic acid, because maybe the rash w/ hydrochlorothiazide(SULFA) so we can NOT use furosemide (SULFA-LIKE), but that reaction does NOT happen w/ Ethacrynic acid
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Old 10-02-2012
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ans=e
May be due to sulfa allergy
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Old 10-02-2012
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i think ......E. Ethacrynic acid
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Old 10-02-2012
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Default EE is correct :)

In most pxts,Furosemide is the 1st choice for diuresis in CHF but it should not be used in pxts with an allergic rxn to non antibiotic sulfonamide medications such as hydrochlorothiazide.This patient has an allergy to thiazides and should not be started on Furosemide.
Instead,Ethacrynic acid should be used.it's a non sulfonamide loop diuretic that is only used in patients with sulfonamide allergies because it carries a higher rate of ototoxicity than Furosemide
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