MEDizzy - A patient with severe infectious disease is being treated

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The Renal System and Diuretics Pharmacology

A patient with severe infectious disease is being treated with an aminoglycoside antibiotic. Which of the following diuretics should be avoided, if possible, for this patient, because of the risk of a serious common and additive adverse effect?

ExplanationBoth the loop diuretics and the aminoglycosides (tobramycin, streptomycin, gentamicin, others) are ototoxic—capable of causing vestibular damage (e.g., balance problems) or cochlear damage (tinnitus or sensorineural hearing loss). The ototoxic effects of each drug is enhanced (often significantly) by the other’s, and so it is best to avoid the use of both these drugs (or other ototoxins) unless the benefits clearly outweigh the risk of perhaps permanent and total hearing loss. Of course, there are instances in which it’s impossible to avoid such combinations. There’s strong evidence that of all the loop diuretics, the risk of ototoxicity is highest with ethacrynic acid (and its parenteral formulation, sodium methacrylate). Nonetheless, all the other loop diuretics—bumetanide, furosemide, and torsemide—are definitely on the short list of ototoxic drugs.