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Summary
Diuretics relieve fluid overload by increasing the volume of urine passed and decreasing the volume of fluid in the body. The consequent challenges to fluid balance require careful observation if dehydration and therapeutic failure are to be avoided. As fluid is lost, so are electrolytes. The subsequent biochemical changes may have adverse effects on patients, however with careful medication monitoring, most of these effects can be detected and prevented.
Keywords
Diuretic therapy, medication management
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Aims and intended learning outcomes
This article aims to update nurses' knowledge of diuretic therapy and encourage the review of medication management. After reading this article and completing the time out activities you should be able to:
* Explain the rationale for the prescription of diuretics in patients with acute and chronic conditions.
* Detect and minimise adverse effects associated with the administration of diuretics.
* Discuss the importance of adherence to prescribed medication regimens.
* Consider strategies to optimise medication management of diuretics.
Introduction
A diuretic is any substance that increases excretion of urine. Diuretics are extensively prescribed to manage conditions that result in, or are caused by, retention of excessive amounts of fluid, most commonly hypertension and heart failure. Commonly prescribed diuretics include:
* Loop diuretics - such as furosemide, bumetanide and torasemide.
* Thiazides - such as bendroflumethiazide, chlortalidone and indapamide.
* Potassium-sparing diuretics - such as amiloride hydrochloride and triamterene, including aldosterone antagonists, such as spironolactone and eplerenone.
Other agents with diuretic actions include mannitoi, which is occasionally prescribed in specialist care, caffeine, alcohol and several herbal preparations, including common tansy, fennel and dandelion root (Wright et al 2007) .
Cardiovascular disease is the main cause of death in the UK, accounting for nearly 198,000 deaths each year (British Heart Foundation 2010) and, after 50 years of clinical use, thiazide diuretics remain an effective prevention (Wright et a/2009). Hypertension is the cause of almost one quarter of myocardial infarctions in...