Which is the diuretic of choice in patients of pulmonary edema-

Ans. is 'a' i.e., Furosemide Pharmacological treatment of acute pulmonary edema* Acute left ventricular failure and pulmonary edema is a medical emergency.* In acute left ventricular failure, there is accumulation of fluid in lungs - acute pulmonary edema.* Loop diuretics (Furosemide) is the DOC for acute pulmonary edema.* In acute left ventricular failure and pulmonary edema, furosemide has benefical effect because of venodilatory action (not because of diuretic action).* Intravenous furosemide causes promt increase in systemic venous capacitance and decreases left ventricular filling pressure even before the diuretic action becomes apparent.I.V. Furosemide|Venodilation|| Venous capacitance|| Preload|| Lt. ventricle filling pressure|| Pulmonary pressurei| Pulmonary edema* In contrast, diuretic action of Furosemide is responsible for symptomatic improveml in chronic heart failure.* Other drugs used for acute pulmonary edema1. Morphine | is a transient venodilator that reduces preload while relieving dysnea and anxiety.2. Nitrates - Act by decreasing preload and L. V. filling pressure.3. ACE inhibitors - Act by reducing both afterload and preload.* Recommended in hypertensive patients.4. Recombinant BNP (Nesiritide) - Acts by reducing preload and afterload.5. Inotropic agents (Dopamine, dobutamine, milirinone)* They act by stimulating cardiac contractility.* They are indicated in patients with acute pulmonary edema with severe left ventricular dysfunction.6.Digitalis glycosides* Once a mainstay of treatment because of their inotropic action, digitalis glycosides are rarely used at present.* However, they may be useful for control of ventricular rate in patients with rapid atrial fibrillation or flutter and LV dysfunction, since they do not have negative inotropic effects of other drugs that inhibit AV node conuction.