Furosemide should not be administered with NSAIDs because latter :
**Core Concept**
Furosemide is a loop diuretic that acts by inhibiting the sodium-potassium-chloride cotransporter in the thick ascending limb of the loop of Henle, leading to increased urine production. The administration of NSAIDs with furosemide can lead to decreased diuretic efficacy due to their effects on renal hemodynamics and prostaglandin synthesis.
**Why the Correct Answer is Right**
NSAIDs inhibit the enzyme cyclooxygenase (COX), which is responsible for the production of prostaglandins. Prostaglandins, particularly PGE2 and PGI2, play a crucial role in maintaining renal blood flow and glomerular filtration rate (GFR) by dilating afferent arterioles and constricting efferent arterioles. When NSAIDs inhibit COX, they reduce prostaglandin production, leading to vasoconstriction of afferent arterioles and a decrease in GFR. This decrease in GFR reduces the effectiveness of furosemide, a diuretic that relies on increased GFR to exert its diuretic effect.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is vague and does not provide a specific mechanism by which NSAIDs would interact with furosemide.
**Option B:** This option is incorrect because NSAIDs do not directly inhibit the sodium-potassium-chloride cotransporter in the thick ascending limb of the loop of Henle.
**Option C:** This option is incorrect because while NSAIDs can affect renal function, they do not directly increase the risk of ototoxicity associated with furosemide.
**Clinical Pearl / High-Yield Fact**
When administering furosemide with NSAIDs, it is essential to monitor renal function closely and adjust the dose of furosemide as needed to maintain adequate diuretic efficacy. Additionally, patients with pre-existing renal impairment may be more susceptible to the adverse effects of this combination.
**Correct Answer: C.**