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seizures (petit mal), generalized tonic-clonic seizures (grand mal), mixed seizure patterns, and myoclonic seizurespecially useful for women who experience an increase in seizures during their menstrual periods. It has also bethe incidence and severity of symptoms of altitude sickness in mountain climbers when taken orally. Additioproduces alkaline urine, which may help to increase the excretion of weakly acidic drugs in cases of drug overdreverse metabolic alkalosis.Pharmacokinetics/DosingAcetazolamide is well absorbed orally. It reaches a peak level in 2 to 4 hours after a 500 mg dose or in 8 to 12 extended-release capsule. Its half-life is 10 to 15 hours, and excretion is mainly by the kidneys. The adult dosagemg PO one to four times daily. The antiepileptic drug dosage is 8 to 30 mg/kg PO divided into four doses per daysickness, the dosage is 500 to 1000 mg daily in divided doses or sustained-release capsules. The safety
acetazolamide in children has not been established. Acetazolamide is also available as a parenteral injection for IVthe current package insert for dosing instructions.Adverse EffectsThe adverse effects of acetazolamide therapy include headaches, increased nervousness, anorexia, nausea, vtremors, rash, alopecia, ataxia, and chest, groin, or leg pain.Drug InteractionsAcetazolamide may increase cyclosporine levels, and may result in decreased lithium levels. By alkalinizing thof amphetamines and salicylates may be affected.(Lasix, Furoside, Apo-Furosemide)Furosemide was the first loop diuretic, most frequently used, and is considered the prototype for the class.IndicationsThe indications for the loop diuretics include the treatment of edema associated with HF, cirrhosis, or renal diused as adjunct therapy in clients with acute pulmonary edema and in clients who are refractory to the other diualso used to treat hypertension, although thiazide diuretics are generally preferred. Use of furosemide does noclients in acute renal failure (Cantarovich, Rangoonwala, Lorenz, Verho, & Esnault, 2004).Pharmacokinetics/DosingFurosemide is fairly well absorbed orally, is highly protein bound, metabolized in the liver, and excreted by theTable 33-1lists the pharmacokinetics and dosage information for the loop diuretics.Adverse EffectsThe most prominent adverse effects of the loop diuretics are dehydration and hypokalemia. Dehydration is parwhen higher doses are used in older adults. Dehydration may be manifested by postural hypotension, confuambulation. Furosemide also increases the excretion of magnesium and calcium, which may result in hhypocalcemia. Furosemide (like bumetanide and torsemide), can produce reversible toxicity to the ear (manifesears) when administered by rapid IV push. (This differs from the ototoxicity of ethacrynic acid, which reototoxicity.) As such, IV doses should be administered slowly over a few minutes. Hyperglycemia, hyperuricemdensity lipoprotein (LDL) cholesterol and triglycerides, and a decrease in high-density lipoprotein (HDL) chol