Reaction Paper On Diuretics

The role of diuretics in heart failure is to reduce the fluid retention by diuresis (1). Patient should be monitored closely to prevent over diuresis that will subsequently lead to hypotension and renal impairment. Diuretic used is commonly associated with hypokalemia (1). Thus, additional potassium needs to be given concurrent to diuretic treatment (1). Patient’s daily weight must be recorded and aimed for reduction of body weight >4.5 kg in 5 days after treatment (7). Angiotensin converting enzyme inhibitor (ACE-I) is a first line agent in treating heart failure, especially when there is evidence of reduced in ejection fraction <40% as it improve survival rate of patient (1). Patient needs to be advised regarding side effects of the drug which are, dry cough, hypotension, renal insufficiency, hyperkalemia and angioedema. Antihypertensive agents that can be given in patient with heart failure are beta blocker, ACE-I and aldosterone antagonist. If the blood pressure is persistently high despite treatment with beta blocker, ACE-I and ARB, calcium channel blocker such as amlodipine can be added as this drugs has negative inotropic effect

Desmopressin decreases the urine volume excreted. Desmopressin is a synthetic substitute for anti-diuretic hormone (ADH). ADH

ADH (Vasopressin) – ADH has an antidiuretic action that prevents the production of dilute urine.

The concern on whether anti-hypertensive’s should be withheld in patients who are hypertensive has been debatable in the recent past. Generally, the treatment of hypertension among hospitalized patients is basically an opportunity to enhance the recognition and treatment of blood pressure (Axon, Nietert & Egan, 2011, p.246). This is mainly because hypertension is a basic risk factor for heart diseases, stroke, and death whose impact is widespread to nearly 70 million adults in America. There have been numerous educational initiatives and publication of treatment processes to address this condition in the past few decades. Despite these measures, nearly 39 million Americans are at risk of hypertension because they have not reached their desired or optimal blood pressure.

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Pharmacological treatments with diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or aldosterone antagonist, and beta-blockers are essential for the treatment of heart failure and are effective in improving symptoms of heart failure and patient well-being. Diuretics are administered to help get rid of the excess fluid that helps improve breathing associated with shortness of breath, at rest or on exertion. Diuretics provide relief from symptoms and signs of pulmonary and venous congestion by promotion of fluid loss through the kidneys. Diuretics, for example, Furosemide helps improve breathing status, but monitoring patients for dehydration and kidney problems is crucial. Patient education is essential to ensuring medication adherence and early identification of adverse effects and potential for drug interactions.

The algorithm begins with an indication that is used for adults over the age of 18 and noted that lifestyle interventions should be continued throughout management. Goal blood pressures are separated by age and presence of chronic disease. The goal for patients over 60 is SBP < 150 mmHg and DBP < 90 mmHg. The goal for patients under 60 is < 140 mmHg and DBP < 90 mmHg. Different goal values are presented for patients with chronic conditions. Treatment with medication is categorized by: general population nonblack, general population black, chronic conditions black, and chronic condition all races. Based on the algorithm black patients should only be prescribed thiazide type diuretics and/or calcium channel blockers. While non-black patients can take all of the medications listed in JNC 8 (thiazide type diuretics, ACEI, ARB, and/or CCB). If patient does not reach goal blood pressure then three strategies are listed, along with lifestyle adherence. The algorithm also explains not to use ACEI and ARB together. The final option for patients not at goal blood pressure includes additional medications and/or referral to physician with an expertise in hypertension

Diuretics inhibit reabsorption of sodium and chloride in the kidneys, and promotes excretion of excess fluid in the body. Diuretics are primarily used to lower blood pressure, and increase urinary output. Triamterene is a generic form of Dyrenium, and is a diuretic medication. Diuretics are not considered to be a controlled substance.

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No more than 2 percent of hypertensive patients can be treated surgically. There are basically four groups of drugs a physician would prescribe a hypertension patient:DiureticsThis is usually the first choice a doctor would prescribe. It helps by increasing the rate you body eliminates urine and salt. However, this can also increase your cholesterol level, make you urinate more frequently, and may cause a loss of potassium.Beta-Adrenergic BlockersThese drugs are usually prescribed if a diuretic does not help bring your blood pressure down, and sometimes are used in combination with diuretics. Beta-adrenergic blockers work by blocking the effects of adrenaline in your body.

The need for evolving guidelines has stemmed from groundbreaking research on the topic of hypertension and antihypertensive medications. In the last two decades, there has been a change

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Atacand HCT (Candesartan celexetil-hydrochlorothiazide) was developed for patients who were unsuccessfully treated with single antihypertensive agents. The proposed benefit is elicited by the drugs action on angiotensin II receptor antagonists, the agent that causes vasoconstriction. Additionally the second ingredient hydrochlorothiazide a diuretic reduces blood pressure by improving the kidneys ability to eliminate salt and fluid from the body (www.centerwatch.com).

Thiazides diuretics reduce sodium reabsorption that leads to increased fluid loss, decrease plasma volume and extracellular fluid. (Drugs.com 2012). Other means of depleting potassium from the body are malignant hypertension (vascular), Type 1 and 2 renal tubular acidosis (Renal), trauma, and diarrhea (Buttarro et. al., 2017). To be able to diagnose Hypokalemia it is important to be aware of the signs and the