An internist asks how to minimize ototoxicity when giving high-dose intravenous furosemide. Which measure best reduces this risk?

• A Administering the dose as a rapid bolus to shorten exposure time
• B Co-administering an aminoglycoside antibiotic to cover infection
• C Infusing the dose slowly over 30 minutes and avoiding aminoglycosides ✓
• D Combining furosemide with hydrochlorothiazide to lower the required dose

Explanation

Loop diuretics impair the endolymph electrolyte composition of the stria vascularis by inhibiting the NKCC cotransporter there, producing reversible sensorineural hearing loss and tinnitus. Risk rises with very high doses, rapid intravenous injection and concurrent ototoxic drugs such as aminoglycosides or vancomycin. Slow infusion and avoiding aminoglycoside combination are the accepted preventive measures.

Reference: Goodman and Gilman's The Pharmacological Basis of Therapeutics, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.