Furosemide (Loop-Diuretics): A Case Study

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1. Furosemide (Loop-diuretics)
Indication: Furosemide is a loop-diuretic that is indicated for use when treating Hypertension, Hyperkalemia, and edema that is from kidney failure, congestive heart failure, or liver cirrhosis.
MOA: Its mechanism of action is to interfere with the chloride-binding cotransport system and inhibits the reabsorption of chloride and sodium ions at the distal and proximal tubules, and the loop of Henle. This leads to the pharmocological effects of enhancing the excretion of multiple ions, including, potassium, chloride, sodium.
Pharm effects:
Evidence: A study was done in Austria that took patients with osteoporosis and osteopenia, gave them furosemide and then measured the pH of their urine. This is important
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When at low doses, inhibits prothrombin to thrombin conversion and inactivates factor Xa. At high doses, it can inhibit fibrinogen to fibrin conversion and also inactivate multiple factors, including factors 9, 19, 11, and 12.
Pharm effects: This leads to the pharmacological effects of increased bleeding time and interference of platelet aggregation, thus preventing blood clots from forming.
Evidence: A study was done in China to determine how heparin affected osteoblasts. They treated human osteoblasts with heparin to see how they were effected. They found that treating the osteoblasts with unfractioned heparin significantly inhibited their growth. It was discovered that heparin did this by inhibiting the expression of FGF2 and HPSE, two important proteins for osteoblast growth.
Source: Xia J, Sheng W, Pei L, Li N, Zhang Z, Wang J, Zu J, Wang N, Wang D. Effects of unfractionated heparin and rivaroxaban on the expression of heparanase and fibroblast growth factor 2 in human osteoblasts. Mol Med Rep. 2017 Jul;16(1):361-366. doi: 10.3892/mmr.2017.6570. Epub 2017 May 10. PubMed PMID:
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Pharm effects: The pharm effects are decreased inflammatory and immune responses. Other effects include controlling the rate of protein synthesis, reversing capillary permeability and suppressing the action and migration of white blood cells.
Evidence: A study was done on rats that were treated with prednisone for 30 and 90 days, and their bone metabolism was tracked. The researchers found that the rats had high bone turnover osteoporosis after consistently taking the prednisone.
Source: Zhang X, Wu X, Min Y, Lu J, Zhang X, Chen W, Zou L, Lv X, Cui L, Xu B. Effect of prednisone treatment for 30 and 90 days on bone metabolism in collagen-induced arthritis (CIA) rats. J Bone Miner Metab. 2017 Nov 9. doi: 10.1007/s00774-017-0880-1. [Epub ahead of print] PubMed PMID: 29124434.

4. Anastrozole (aromatase inhibitors)
Indication: Anastrozole is used as a first-line therapy for postmenopausal women with breast cancer. It can also be used to prevent cancer in those who are considered high risk for the

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