Reyes A J
Arch Inst Cardiol Mex. 1981 May-Jun;51(3):291-303.
Diuretics may have high, medium or low diuretic potency and their main site of diuretic action at the ascending limb of Henle's loop or at different biochemical sites of the distal tubulus. Loop diuretics have high diuretic potency, act abruptly, are not antihypertensives when prescribed as a monotherapy and are potentially ototoxic. The diuretics acting at the distal tubulus have a gentle time-course of diuretic activity and variable potencies and other properties. The mose frequent side-effect of diuretics is hypokalemia, whose development may be partially prevented by the prescription of a sodium restricted diet. Arrhythmias provoked by diuretics-induced hypokalaemia should be treated with magnesium and potassium. The most frequent drug interaction of diuretics is with unspecific inhibitors of prostaglandin's synthesis (aspirin and indomethacin) which decrease diuretic effects. Diuretics are indicated in the treatment of acute heart failure because of their direct and indirect vasoactive properties, in the treatment of chronic cardiac insufficiency because of their diuretic and vasodilatatory properties and, those diuretics which show as antihypertensives, are first choice drugs in hypertension.
利尿剂的利尿效力可高、中或低，其主要利尿作用部位在髓袢升支或远曲小管的不同生化位点。袢利尿剂利尿效力高，起效迅速，单药使用时无降压作用，且有潜在耳毒性。作用于远曲小管的利尿剂利尿活性时间进程平缓，效力及其他特性各异。利尿剂最常见的副作用是低钾血症，通过限制钠饮食的处方可部分预防其发生。利尿剂所致低钾血症引发的心律失常应用镁和钾进行治疗。利尿剂最常见的药物相互作用是与非特异性前列腺素合成抑制剂（阿司匹林和吲哚美辛），这会降低利尿效果。由于其直接和间接的血管活性特性，利尿剂适用于急性心力衰竭的治疗；由于其利尿和血管舒张特性，适用于慢性心功能不全的治疗；而那些具有降压作用的利尿剂是高血压的首选药物。
