A patient with acute pulmonary edema is coughing pink frothy sputum. Which medication is expected first?

Acute pulmonary edema is a life-threatening emergency characterized by fluid flooding the alveoli, causing impaired gas exchange. Pink frothy sputum is a hallmark sign, resulting from the mixing of fluid, air, and blood-tinged plasma in the airways. The priority pharmacological intervention is furosemide, a loop diuretic, which rapidly reduces preload by promoting venous dilation within minutes of intravenous administration and then causing brisk diuresis to relieve the excess fluid in the lungs. This dual mechanism — venodilation followed by diuresis — quickly reduces pulmonary congestion and improves oxygenation. Insulin is used for diabetes or hyperkalemia management and has no role in treating pulmonary edema. Antibiotics target infection, and while pneumonia can trigger pulmonary edema, the immediate treatment is fluid reduction, not antibiotics. Warfarin is an anticoagulant used for thromboembolic conditions and would not relieve acute pulmonary congestion. Furosemide directly addresses the pathophysiology of acute cardiogenic pulmonary edema, making it the first expected medication in this emergency.