NursingSprint

✔️ Furosemide:

is a potent loop diuretic that causes sodium and water depletion. Low sodium levels significantly increase lithium reabsorption in the kidneys, heightening the risk for lithium toxicity, which can present with confusion, tremors, nausea, seizures, and cardiac arrhythmias.

✔️ Nurse's clinical responsibility:

includes identifying dangerous medication interactions before initiating therapy. When a client is prescribed furosemide and is already taking lithium, it is critical to alert the provider immediately to either adjust the therapy or implement close serum lithium monitoring protocols.

✔️ Clinical best practices:

from sources such as the American Psychiatric Association advise caution and emphasize that when diuretics and lithium are used together, monitoring serum lithium levels twice weekly during therapy initiation and after dose changes is essential to prevent toxicity.

✔️ The nurse should educate the client on early signs of lithium toxicity, including muscle weakness, increasing confusion, and gastrointestinal distress, and reinforce the importance of maintaining proper hydration to minimize renal retention of lithium.

Educational Insight:

Evidence-based guidelines caution against combining diuretics like furosemide with lithium unless necessary. If unavoidable, frequent monitoring of lithium levels, renal function tests, and electrolyte panels are recommended to prevent severe toxicity, especially in vulnerable populations like older adults.

Incorrect Options:

B. Albuterol

Albuterol is a beta-2 agonist used for bronchodilation in conditions like asthma and COPD. It does not affect sodium balance or interact significantly with furosemide. While albuterol can cause hypokalemia (low potassium), it is not contraindicated with diuretics like furosemide, though potassium levels should still be monitored.

C. Levothyroxine

Levothyroxine is a thyroid hormone replacement used for treating hypothyroidism. It does not alter renal sodium handling or directly interact with furosemide. Therefore, it is not considered contraindicated. However, nurses should still monitor cardiac function when both drugs are given due to potential effects on heart rate and rhythm.

D. Cetirizine

Cetirizine is a second-generation antihistamine used primarily to treat allergic rhinitis or urticaria. It has no significant interaction with furosemide. The only caution is its potential for sedation, but this is not an issue specific to diuretic use.