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tvpjournal.com | January/February 2016 | Today's VeTerinary PracTice PracTicaL TecHniQUes FroM THe naVc insTiTUTe Peer reviewed 99 diuretics are a critical component of the pharmacotherapy of congestive heart failure (cHF) (typically pulmonary edema or ascites). in humans with heart failure, 90% receive at least one type of diuretic. 1 of these, loop diuretics—furosemide, bumetanide, and torsemide—are the most potent and commonly used. When a single drug is administered in humans, furosemide is given 87% of the time. 1 Furosemide has been, and remains, the diuretic of choice for acute and chronic management of cHF in both humans and animals since its release in 1966. However, interesting alternatives and adjunctive therapies are now available, including: • Torsemide, a loop diuretic that can be used as an adjunct or alternative to furosemide • s pironolactone, a weak, potassium-sparing diuretic and mineralocorticoid receptor (Mr) blocker that is used primarily for additional blockade of the renin–angiotensin–aldosterone system (raas). in heart failure, it typically accompanies a more potent diuretic, such as furosemide. This article, the frst in a 2-part series, discusses torsemide, while the second article will address spironolactone. LOOP DIURETICS Loop diuretics, in general, exemplify the phrase "double-edged sword": They are typically necessary—often lifesaving—yet are invariably harmful in some respects, particularly with long-term use (Table 1, page 100). 2 although adverse effects differ among the loop diuretics, complications are common to all diuretics. Loop diuretics are pyridine-3-sulfonurea drugs that act on the thick portion of the nephron's ascending loop of Henle, where they inhibit the sodium–potassium–chloride (na + –K + –2cl – ) cotransporter, leaving sodium (and other ions) to be lost, with water, in the urine. FUROSEMIDE For nearly 50 years, furosemide has been a workhorse for cardiologists and internists. it has undoubtedly saved countless lives when used to manage acute/ emergent heart failure and has increased the longevity of patients when used long term. Furosemide is typically not used as a monothera - py but rather given concurrently with: • Inotropes: Pimobendan, digoxin, or dobutamine • Other diuretics: Thiazides and/or potassium- sparing diuretics Beyond Furosemide: The role oF diureTics in congesTive hearT Failure Part 1: Torsemide Marisa K. Ames, DVM, Diplomate ACVIM (Cardiology) Colorado State University Clarke E. Atkins, DVM, Diplomate ACVIM (Internal Medicine & Cardiology) North Carolina State University Each year, the navc institute takes place in Orlando, Florida, and top specialists in select areas of veterinary medicine provide hands-on, one-on-one continuing education to the Institute attendees. Practical Techniques from the navc institute—brought to you by the navc and Today's Veterinary Practice —provides the opportunity for you to experience the excellent education provided at the Institute within the pages of this journal. This article reviews information from the session, cardiology Without intimidation, presented at the NAVC Institute 2014. The NAVC Institute 2016 takes place in Orlando, Florida, May 15 to 20; visit navc.com/institute for further information.