Torsemide

INTRODUCTION

Indications

Edema due to CHF; Hepatic or renal disease; Hypertension.

Action

Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule. ↑ renal excretion of water, sodium, chloride, magnesium, hydrogen, and calcium. Effectiveness persists in impaired renal function. Therapeutic Effects: Diuresis and subsequent mobilization of excess fluid (edema, pleural effusions). ↓ blood pressure.

Adverse Reactions/Side Effects

CNS: dizziness, headache, nervousness. EENT: hearing loss, tinnitus. CV: hypotension. GI: constipation, diarrhea, dry mouth, dyspepsia, nausea, vomiting. GU: excessive urination. Derm: photosensitivity, rash. Endo: hyperglycemia, hyperuricemia. F and E: dehydration, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis. MS: arthralgia, muscle cramps, myalgia. Misc: increased BUN.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of metabolic acidosis, including headache, lethargy, stupor, seizures, vision disturbances, increased respiration, cardiac arrhythmias, weakness, nausea, vomiting, and abdominal pain. Notify physician immediately if these signs occur.

• Monitor neuromuscular signs of fluid and electrolyte imbalances (hypocalcemia, hypokalemia, hyponatremia, hypovolemia, hypomagnesemia), including muscle aches, cramping, hyperexcitability, tremors, and tetany. Notify physician immediately if these signs occur.

• Assess blood pressure periodically and compare to normal values (See Appendix F) to help document antihypertensive effects. Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.

• When used to treat edema, help determine drug effects by assessing peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Also monitor signs of pulmonary edema such as dyspnea and rales/crackles (See Appendix K). Document whether peripheral and pulmonary symptoms are controlled adequately by diuretic therapy.

• Be alert for signs of hyperglycemia, including confusion, drowsiness, flushed/dry skin, fruit-like breath odor, rapid/deep breathing, polyuria, loss of appetite, and unusual thirst. Patients with diabetes mellitus should check blood glucose levels frequently.

• Assess any muscle or joint pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug-induced rather than caused by anatomical or biomechanical problems.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

Interventions

• Implement fall-prevention strategies, especially in older adults or if patient exhibits sedation, dizziness, blurred vision, or other impairments that affect gait and balance (See Appendix E).

• Use caution during aerobic exercise, especially in hot environments. Increased sweating will cause fluid and electrolyte loss, and may exaggerate metabolic acidosis and diuretic side effects (dizziness, muscle cramps, and so forth).

• To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.

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