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hey this is dr. busty and welcome to another session where well be covering some core pharmacology were going to be diving a little deeper into a very specific clinical scenario in question related to the use of furosemide IV overusing it by mouth and patients with CHF exacerbations so lets start off with a little bit of a case this is a 55 year old male with a past medical history of hypertension hyperlipidemia diabetes known heart failure with an ejection fraction of approximately 20% who comes in with progressively worsening shortness of breath just beyond exertion lower extremity edema extending all the way up into the thighs and a 10-pound weight gained over the past week he reports being compliant and taking his diuretics but he says that his urine output has decreased we look at his medications on the classic medications for all of these conditions including lisinopril which is your ACE inhibitor metoprolol succinate which is topo XL FDA approved for heart failure furosemide