221 ) A 73-year-old white man with type 2 diabetes mellitus, hypertension, coronary artery disease is admitted with increasing shortness of breath and lower-extremity edema. A brain natriuretic peptide level is 1000 pg/ml. His medications include glyburide, aspirin, atorvastatin and enalapril. He is allergic to sulfonamides. On physical examination, he has bilateral crepitations more in the right chest. Extremity examination reveals 3+ edema bilaterally. An electrocardiogram reveals changes consistent with left venricular hypertrophy but no evidence of acute ischemia. Cardiac enzymes are negative. A chest x-ray reveals bilateral pulmonary edema. Pulse oximetry reveals a saturation of 89% on room air. The patient is started on oxygen by nasal cannula. Which of the following is the most appropriate next step in management?
A) Intubation
B) Intravenous Furosemide
C) Bilevel Positive Airway pressure (BIPAP)
D) Intravenous Ethacrynic acid
E) Cardiac catheterization.
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intravenous furosemide
b
b
D…..Intravenous Ethacrynic acid
Unlike the other loop diuretics, etacrynic acid is not a sulfonamide[1] and thus, its use is not contraindicated in those with sulfa allergies
D.
Ethacrynic acid.
D:) Ethacrynic acid
Patient has sulfa allergy.
List of sulfonamides[edit]
Child antibacterial drugs[edit]
Pediazole[13]
Antibacterial Drugs[edit]
Short-acting
Sulfamethoxazole
Sulfisomidine (also known as sulfaisodimidine)
Sulfadiazine
Intermediate-acting
Sulfacetamide[14]
Sulfadoxine
Ophthalmologicals
Dichlorphenamide (DCP)
Sulfonylureas (anti-diabetic agents)[edit]
Carbutamide
Acetohexamide
Chlorpropamide
Tolbutamide
Tolazamide
Glipizide
Gliclazide
Glibenclamide (glyburide)
Glibornuride
Gliquidone
Glisoxepide
Glyclopyramide
Glimepiride
Diuretics[edit]
Acetazolamide
Bumetanide
Chlorthalidone
Clopamide
Dorzolamide
Furosemide
Hydrochlorothiazide (HCT, HCTZ, HZT)
Indapamide
Mefruside
Metolazone
Xipamide
Anticonvulsants[edit]
Acetazolamide
Ethoxzolamide
Sultiame
Zonisamide
Dermatologicals[edit]
Mafenide
Other[edit]
Celecoxib (COX-2 inhibitor)
Darunavir (Protease Inhibitor)
Fosamprenavir (Protease Inhibitor)
Tipranavir (Protease Inhibitor)
Probenecid (PBN)
Sotalol (Beta-blocker)
Sulfasalazine (SSZ)
Sumatriptan (SMT)
Delavirdine (NNRTI)
Tamsulosin (Flomax)