Common Types, Examples, and Nursing Considerations
Diuretic drugs are medications that increase urine output by affecting how the kidneys handle water, sodium, and electrolytes. Nursing and healthcare students need a clear diuretic drugs list because these medications are usually studied by class, drug name, clinical association, electrolyte risk, side effect pattern, and nursing monitoring priority.
This article organizes common diuretic medications by class so students can quickly identify which drugs are thiazide, loop, potassium-sparing, osmotic, or carbonic anhydrase inhibitor diuretics. For the complete foundation on mechanisms, broad uses, side effects, electrolytes, and nursing care across all diuretics, review the main pillar article first. This supporting guide focuses on drug names and class organization rather than repeating every detail from the class-specific articles.
Diuretics are sometimes called water pills, but that term is incomplete. These drugs may affect potassium, sodium, magnesium, calcium, blood pressure, renal function, fluid status, dizziness risk, and patient safety. Students should therefore learn diuretic drugs by class, not as random medication names.
This article is for nursing and healthcare education only. It does not replace clinical judgment, provider orders, institutional policy, or medication guidance from a licensed healthcare professional.
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What Are Diuretic Drugs?
Diuretic drugs are medications that increase urine output through kidney-related effects on sodium, water, or electrolytes. They may be prescribed in selected conditions involving hypertension, edema, heart failure-related fluid overload, fluid retention, kidney-related fluid concerns, or specialty clinical contexts depending on provider assessment.
Why Students Should Learn Diuretics by Class
The safest way to study diuretic medications is by class. A drug’s class helps students predict its likely site of action, common clinical association, electrolyte risk, side effect pattern, and nursing monitoring focus. StatPearls explains that diuretics are used in edematous and non-edematous disease states and are grouped by pharmacologic action and clinical use (Arumugham & Shahin, 2023).
| Term | Meaning |
|---|---|
| Diuretic drugs | Medications that increase urine output through kidney-related effects |
| Water pills | Common patient-friendly term for diuretics |
| Diuretic class | A group of diuretic drugs that work in a similar way |
| Electrolyte risk | A possible change in potassium, sodium, magnesium, calcium, or related lab values |
| Nursing consideration | Assessment, monitoring, documentation, education, or reporting priority related to medication safety |
Students should avoid memorizing diuretic names without context. For example, knowing that furosemide is a loop diuretic immediately connects it with stronger fluid removal, potassium monitoring, blood pressure changes, and renal function review. Knowing that spironolactone is potassium-sparing connects it with hyperkalemia risk instead of potassium loss.
Diuretic Drugs List by Class
The main diuretic drug classes include thiazide and thiazide-like diuretics, loop diuretics, potassium-sparing diuretics, osmotic diuretics, and carbonic anhydrase inhibitors. Each class has different examples and monitoring priorities.
| Diuretic Class | Common Drug Examples | Main Student Memory Point |
|---|---|---|
| Thiazide and thiazide-like diuretics | Hydrochlorothiazide, chlorthalidone, indapamide, metolazone | Commonly associated with hypertension and mild fluid retention |
| Loop diuretics | Furosemide, bumetanide, torsemide, ethacrynic acid | Often associated with stronger fluid removal |
| Potassium-sparing diuretics | Spironolactone, eplerenone, amiloride, triamterene | Help conserve potassium but may increase hyperkalemia risk |
| Osmotic diuretics | Mannitol | Work through osmotic pressure and fluid shifts |
| Carbonic anhydrase inhibitors | Acetazolamide | Used in selected specialty contexts |
This table is a starting point, not a full treatment guide. Students should use it to match each drug to its class, then connect that class with electrolyte risks and nursing monitoring. Class-specific guides can provide deeper learning, while this page helps students organize the medication names.
Thiazide and Thiazide-Like Diuretic Drugs
Thiazide and thiazide-like diuretics are commonly associated with hypertension and mild fluid retention. They act mainly in the distal convoluted tubule and reduce sodium-chloride reabsorption. Hydrochlorothiazide is a thiazide diuretic approved for hypertension and peripheral edema, and it works by inhibiting sodium reabsorption in the distal convoluted tubule (Herman & Bashir, 2023).
Common Thiazide Drug Names
The main thiazide and thiazide-like drugs students commonly encounter are hydrochlorothiazide, chlorthalidone, indapamide, and metolazone. Chlorthalidone is a thiazide-like diuretic used in hypertension and edema contexts, with monitoring needs that include electrolytes and renal function (Patel, 2024).
| Drug | Type | Key Student Note | Major Monitoring Focus |
|---|---|---|---|
| Hydrochlorothiazide | Thiazide diuretic | Common blood pressure-related diuretic | Blood pressure, potassium, sodium |
| Chlorthalidone | Thiazide-like diuretic | Longer-acting thiazide-like drug | Blood pressure, electrolytes |
| Indapamide | Thiazide-like diuretic | Used in some blood pressure contexts | Blood pressure, sodium, potassium |
| Metolazone | Thiazide-like diuretic | May be used in more complex fluid situations | Fluid status, electrolytes, renal function |
Students should connect thiazide drugs with blood pressure monitoring, potassium and sodium checks, dizziness assessment, and metabolic concerns where clinically relevant. For deeper class-specific learning, review thiazide diuretics.
Loop Diuretic Drugs
Loop diuretics are often associated with stronger diuresis and clinically significant fluid overload. They act mainly in the loop of Henle, especially the thick ascending limb. Loop diuretics inhibit sodium-potassium-chloride reabsorption, which helps explain their stronger fluid-removal effect (Huxel et al., 2023).
Common Loop Drug Names
Common loop diuretic drugs include furosemide, bumetanide, torsemide, and ethacrynic acid. Furosemide is a loop diuretic approved for conditions involving volume overload and edema, including heart failure exacerbation, liver failure, renal failure, and nephrotic syndrome (Khan et al., 2023). Bumetanide is also a loop diuretic used for edematous conditions related to cardiac, hepatic, or renal disease (Sidhu et al., 2023).
| Drug | Type | Key Student Note | Major Monitoring Focus |
|---|---|---|---|
| Furosemide | Loop diuretic | Commonly associated with edema and fluid overload | Potassium, fluid status, blood pressure, renal function |
| Bumetanide | Loop diuretic | Potent loop diuretic | Fluid status, electrolytes, renal function |
| Torsemide | Loop diuretic | Loop diuretic used in fluid overload contexts | Fluid status, potassium, renal function |
| Ethacrynic acid | Loop diuretic | Non-sulfonamide loop diuretic discussed in special cases | Electrolytes, renal function, hearing-related safety where relevant |
Loop drugs require students to think about fluid status, potassium loss, renal function, blood pressure, dizziness, dehydration, and fall risk. For more detailed class-level learning, review loop diuretics. Furosemide-specific risks and monitoring should be covered in separate furosemide side effects and furosemide nursing considerations articles.
Potassium-Sparing Diuretic Drugs
Potassium-sparing diuretics help remove sodium and water while reducing potassium loss. Their major safety concern is often high potassium, not low potassium. Students should remember this opposite pattern clearly: loop and thiazide drugs may lower potassium, while potassium-sparing drugs may increase potassium.
Common Potassium-Sparing Drug Names
Common potassium-sparing drugs include spironolactone, eplerenone, amiloride, and triamterene. Spironolactone and eplerenone are aldosterone antagonists. Amiloride and triamterene are epithelial sodium channel blockers. Spironolactone is used in selected conditions including heart failure, edema, ascites, and hypertension contexts, but monitoring for hyperkalemia and renal function is important (Patibandla et al., 2023). Amiloride is a potassium-sparing diuretic that helps conserve potassium through effects in the distal nephron (Almajid & Cassagnol, 2024).
| Drug | Type | Key Student Note | Major Monitoring Focus |
|---|---|---|---|
| Spironolactone | Aldosterone antagonist | Common potassium-sparing example | Potassium, renal function, blood pressure |
| Eplerenone | Aldosterone antagonist | More selective aldosterone antagonist | Potassium, renal function |
| Amiloride | ENaC blocker | Helps conserve potassium | Potassium, renal function |
| Triamterene | ENaC blocker | Potassium-sparing option often discussed with combination therapy | Potassium, renal function |
Students should connect potassium-sparing drugs with hyperkalemia risk, renal function review, blood pressure monitoring, and medication profile review. For deeper class-specific learning, review potassium-sparing diuretics.
Osmotic Diuretic Drugs
Osmotic diuretics are specialty-focused and work through osmotic pressure rather than the same sodium-transporter mechanisms as thiazide or loop diuretics. Mannitol is the main osmotic diuretic students commonly learn.
Mannitol is filtered into the renal tubules and remains in the tubular fluid, increasing osmotic pressure and helping hold water in the urine-forming fluid. It is associated with selected monitored uses, including intracranial pressure, cerebral edema, intraocular pressure, and specific renal or toxic-excretion contexts under provider direction (Patel, 2024).
| Drug | Type | Key Student Note | Major Monitoring Focus |
|---|---|---|---|
| Mannitol | Osmotic diuretic | Main osmotic diuretic students commonly learn | Urine output, fluid shifts, renal function, osmolality where ordered |
Students should connect mannitol with osmotic pressure, fluid shifts, renal monitoring, intake and output, neurological assessment where relevant, and closely monitored clinical settings. It should not be treated as a routine outpatient water pill. For more detail, review osmotic diuretics.
Carbonic Anhydrase Inhibitor Diuretic Drugs
Carbonic anhydrase inhibitors are diuretic-related medications used in selected specialty contexts. This class is usually less central to nursing-student diuretic lists than thiazide, loop, potassium-sparing, and osmotic diuretics, but students may still encounter it in pharmacology.
Acetazolamide
Acetazolamide is the main carbonic anhydrase inhibitor students commonly associate with this class. It acts mainly in the proximal tubule by inhibiting carbonic anhydrase, affecting bicarbonate handling and acid-base balance. StatPearls describes acetazolamide as a carbonic anhydrase inhibitor used in selected conditions, including glaucoma, altitude sickness prevention, and other specialty contexts (Maren, 2023).
| Drug | Type | Key Student Note | Major Monitoring Focus |
|---|---|---|---|
| Acetazolamide | Carbonic anhydrase inhibitor | Used in selected specialty contexts | Electrolytes, acid-base balance, renal function |
This section should stay brief unless a future article targets carbonic anhydrase inhibitors specifically.
Diuretic Drugs and Electrolyte Risks
Electrolyte risks are one of the most important reasons students must learn diuretic drugs by class. Not all diuretics have the same potassium pattern. Not all electrolyte risks are limited to potassium.
| Diuretic Class | Common Drugs | Main Electrolyte Concern |
|---|---|---|
| Thiazide diuretics | Hydrochlorothiazide, chlorthalidone | May lower potassium or sodium; may affect calcium, glucose, or uric acid |
| Loop diuretics | Furosemide, bumetanide, torsemide | May lower potassium, magnesium, sodium, or calcium |
| Potassium-sparing diuretics | Spironolactone, amiloride | May increase potassium |
| Osmotic diuretics | Mannitol | May affect fluid balance, sodium, potassium, and osmolality |
| Carbonic anhydrase inhibitors | Acetazolamide | May affect bicarbonate, electrolytes, and acid-base balance |
Potassium Monitoring
Potassium monitoring matters for many diuretic drugs. Loop and thiazide diuretics may lower potassium, which can affect muscle function and cardiac rhythm. Potassium-sparing diuretics may increase potassium, which can also affect cardiac safety. The Merck Manual identifies diuretics as a common medication-related cause of hypokalemia, particularly potassium-wasting diuretics (Merck Manual Professional Edition, n.d.-a).
Hyperkalemia Risk
Potassium-sparing diuretics create a different safety concern: hyperkalemia. Hyperkalemia risk may increase with renal impairment or potassium-increasing medications. MSD Manual lists potassium-sparing diuretics, ACE inhibitors, ARBs, NSAIDs, and other medication groups among possible contributors to hyperkalemia (MSD Manual Professional Edition, 2024).
Sodium, Renal Function, and Fluid Status
Sodium monitoring matters because diuretics can alter sodium and water balance. Hyponatremia may affect neurological status and fall risk. Renal function matters because diuretics act through the kidneys and because fluid shifts can affect kidney perfusion. Blood pressure and fluid status matter because diuretics can change circulating volume, which may contribute to dizziness, hypotension, dehydration, or fall risk.
Diuretic Drugs Side Effects by Class
Side effects vary by drug, class, dose, route, patient condition, renal function, hydration status, age, and other medications. Students should connect side effects to assessment findings, lab monitoring, patient symptoms, and safety precautions.
| Class | Possible Side Effects or Risks | Student Nursing Focus |
|---|---|---|
| Thiazide diuretics | Dizziness, hypokalemia, hyponatremia, increased uric acid, glucose changes | Blood pressure, potassium, sodium, gout or diabetes risk where relevant |
| Loop diuretics | Dehydration, hypotension, hypokalemia, hypomagnesemia, ototoxicity risk | Fluid status, potassium, magnesium, renal function, hearing changes where relevant |
| Potassium-sparing diuretics | Hyperkalemia, dizziness, renal function changes, endocrine effects with some drugs | Potassium, renal function, medication interactions |
| Osmotic diuretics | Fluid shifts, dehydration, electrolyte imbalance, pulmonary congestion risk in susceptible patients | Intake and output, renal function, osmolality where ordered, lung sounds |
| Carbonic anhydrase inhibitors | Electrolyte or acid-base concerns, selected drug-specific effects | Electrolytes, acid-base balance, renal function |
How Students Should Interpret Side Effects
Students should avoid memorizing side effects as isolated lists. A better approach is to ask: What class is this drug? What electrolyte changes are expected? And what patient symptoms might appear? What should the nurse monitor and report?
For example, dizziness may connect with blood pressure or fluid-volume changes. Muscle cramps may suggest electrolyte concerns. Confusion may raise concern for sodium or neurological changes. Hearing changes may matter with some loop diuretic contexts. The nurse’s role is to assess, document, educate, and report according to provider orders and institutional policy.
Nursing Considerations for Diuretic Drugs
Nursing considerations for diuretic drugs should be class-organized and safety-focused. Nurses assess, monitor, administer medications as prescribed, document findings, educate patients, and report concerns. Providers diagnose, prescribe, and adjust treatment.
Identify the Class First
Before focusing on the drug name, students should identify the class. Hydrochlorothiazide, furosemide, spironolactone, mannitol, and acetazolamide do not have the same monitoring priorities. The class helps predict likely electrolyte risks, fluid effects, and nursing assessment needs.
Monitor Blood Pressure and Fluid Status
Nurses check blood pressure according to orders and institutional policy. They may monitor intake and output where ordered, daily weight where ordered, edema, lung sounds, shortness of breath, dizziness, weakness, dehydration signs, and fluid response.
Monitor Electrolytes and Renal Function
Ordered laboratory monitoring may include potassium, sodium, magnesium, calcium, renal function markers, acid-base indicators, or osmolality depending on the medication class and clinical context. Nurses should watch for hypokalemia with loop and thiazide diuretics and hyperkalemia with potassium-sparing diuretics.
Review Medication Profile and Safety Concerns
Medication profile review is important within nursing scope. Nurses may identify duplicate diuretic therapy, potassium supplements, salt substitutes, ACE inhibitors, ARBs, NSAIDs, or other medications that could affect potassium, blood pressure, renal function, or hydration.
Nurses do not independently change therapy. They identify concerns, document findings, reinforce safe education, and report possible issues according to policy. Students can review diuretics nursing considerations for broader monitoring guidance.
Patient Education for Diuretic Drugs
Patient education should be safe, practical, and based on provider instructions. Patients should take diuretic medication exactly as prescribed and should not stop or change it without provider guidance.
Teaching About Urination and Timing
Many diuretics increase urination. If frequent urination disrupts sleep, patients should ask the provider or pharmacist about medication timing. Nurses should not provide independent timing changes unless those instructions are part of the prescribed plan or institutional guidance.
Teaching About Symptoms to Report
Patients should report severe weakness, confusion, fainting, palpitations, severe dizziness, breathing difficulty, hearing changes, muscle cramps, or unusual symptoms. These symptoms may relate to electrolyte imbalance, blood pressure changes, fluid-volume changes, renal concerns, or medication effects.
Teaching About Labs, Diet, and Supplements
Patients should keep follow-up appointments and lab tests when ordered. They should follow provider instructions about sodium, potassium, fluid intake, and diet. Patients should avoid starting supplements, herbal products, salt substitutes, or natural diuretics without professional guidance.
If patients are told to monitor weight, they should follow the care team’s instructions. They should also rise slowly if dizziness occurs and use fall-prevention strategies when appropriate.
How to Remember Diuretic Drugs for Nursing School
Diuretic drugs become easier to learn when students organize them by class. Start with the class, then add drug names, site or mechanism, electrolyte risk, and monitoring priority.
Step 1: Learn the Classes
The main classes are thiazide, loop, potassium-sparing, osmotic, and carbonic anhydrase inhibitor diuretics. Each class has a different pattern.
Step 2: Memorize Common Examples
Hydrochlorothiazide and chlorthalidone belong with thiazides. Furosemide and bumetanide belong with loop diuretics. Spironolactone and amiloride belong with potassium-sparing diuretics. Mannitol belongs with osmotic diuretics. Acetazolamide belongs with carbonic anhydrase inhibitors.
Step 3: Link Each Class to Electrolytes
Loop and thiazide diuretics often raise concern for low potassium. Potassium-sparing diuretics raise concern for high potassium. Osmotic diuretics raise concern for fluid shifts, sodium, potassium, renal function, and osmolality where ordered. Carbonic anhydrase inhibitors raise concern for bicarbonate, acid-base balance, and electrolytes.
Step 4: Connect the Drug to Nursing Monitoring
Ask four questions: What class is it? What electrolyte risk matters most? Which patient symptoms take assessment priority? What should be documented and reported?
Student memory point: Learn diuretic drugs by class first. Loop and thiazide diuretics often raise concern for low potassium, potassium-sparing diuretics raise concern for high potassium, and osmotic diuretics raise concern for fluid shifts, renal function, and osmolality where ordered.
Common Mistakes Students Make With Diuretic Drugs
A common mistake is memorizing drug names without learning the class. A drug name alone does not tell the full nursing story. The class helps predict the mechanism, electrolyte risk, side effects, and monitoring priority.
Another mistake is thinking all diuretics work the same way. Thiazides, loops, potassium-sparing drugs, osmotic diuretics, and carbonic anhydrase inhibitors differ in site of action and safety concerns.
Students also often think all diuretics lower potassium. This is incorrect. Potassium-sparing diuretics may increase potassium.
Some students confuse loop and thiazide diuretics. Loop diuretics act in the loop of Henle and are often associated with stronger fluid removal. Thiazides act mainly in the distal convoluted tubule and are commonly associated with blood pressure management.
Another mistake is treating mannitol like a routine outpatient water pill. Mannitol is an osmotic diuretic associated with selected monitored clinical situations.
Students may also ignore renal function, focus only on urine output, miss dehydration or dizziness, and give unsafe patient advice about sodium, potassium, fluids, salt substitutes, or supplements. Patients should follow provider instructions and speak with a healthcare professional before making changes.
Summary: What Students Should Remember About Diuretic Drugs
A diuretic drugs list helps nursing students organize medication names by class. Diuretic drugs increase urine output through kidney-related effects and are grouped based on how and where they work.
Common classes include thiazide and thiazide-like diuretics, loop diuretics, potassium-sparing diuretics, osmotic diuretics, and carbonic anhydrase inhibitors. Common examples include hydrochlorothiazide, chlorthalidone, indapamide, metolazone, furosemide, bumetanide, torsemide, ethacrynic acid, spironolactone, eplerenone, amiloride, triamterene, mannitol, and acetazolamide.
Students should connect each drug to its class, electrolyte risk, monitoring priority, side effect pattern, and patient teaching point. Patient education should remain safe and based on provider instructions.
Need Help Learning Diuretic Drugs?
Diuretic drugs can be confusing because students must remember class names, drug examples, electrolyte risks, renal function concerns, side effects, and nursing monitoring priorities. If you need help with a nursing pharmacology assignment, medication table, case study, care plan, or patient education project, our academic support team can help you create clear, evidence-based work.
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Frequently Asked Questions About Diuretic Drugs
What are diuretic drugs?
Diuretic drugs are medications that increase urine output by affecting how the kidneys handle water, sodium, and electrolytes. They are commonly called water pills, but that term is incomplete because diuretics can also affect potassium, sodium, magnesium, calcium, blood pressure, renal function, and fluid status.
What are common examples of diuretic drugs?
Common examples include hydrochlorothiazide, chlorthalidone, indapamide, metolazone, furosemide, bumetanide, torsemide, ethacrynic acid, spironolactone, eplerenone, amiloride, triamterene, mannitol, and acetazolamide.
What are the main classes of diuretic drugs?
The main classes include thiazide and thiazide-like diuretics, loop diuretics, potassium-sparing diuretics, osmotic diuretics, and carbonic anhydrase inhibitors. Each class has different mechanisms, examples, electrolyte risks, and nursing monitoring priorities.
Is furosemide a diuretic drug?
Yes. Furosemide is a loop diuretic. It is commonly associated with edema and fluid overload when prescribed. Students should connect it with fluid status, potassium monitoring, blood pressure, renal function, and dehydration risk.
Is hydrochlorothiazide a diuretic drug?
Yes. Hydrochlorothiazide is a thiazide diuretic. It is commonly associated with hypertension and peripheral edema management when prescribed. Students should connect it with blood pressure, potassium, sodium, and renal monitoring where clinically indicated.
Is spironolactone a diuretic drug?
Yes. Spironolactone is a potassium-sparing diuretic and aldosterone antagonist. It may be discussed in selected heart failure, edema, ascites, and resistant hypertension contexts under provider direction. Its major electrolyte concern is hyperkalemia.
Which diuretic drugs can lower potassium?
Loop diuretics such as furosemide, bumetanide, and torsemide may lower potassium. Thiazide diuretics such as hydrochlorothiazide and chlorthalidone may also lower potassium. Potassium should be monitored where ordered.
Which diuretic drugs can increase potassium?
Potassium-sparing diuretics such as spironolactone, eplerenone, amiloride, and triamterene may increase potassium. Hyperkalemia risk may be higher in patients with renal impairment or other potassium-increasing medications.
What should nurses monitor with diuretic drugs?
Nurses may monitor blood pressure, intake and output, daily weight where ordered, edema, lung sounds, dizziness, weakness, dehydration signs, electrolytes, renal function, medication profile, and patient symptoms according to provider orders and institutional policy.
Are diuretic drugs the same as water pills?
“Water pills” is a common patient-friendly term for diuretic drugs, but it oversimplifies their effects. Diuretics can affect electrolytes, blood pressure, renal function, fluid status, and patient safety, not just water removal.
References
Almajid, A. N., & Cassagnol, M. (2024). Amiloride. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK542303/
Arumugham, V. B., & Shahin, M. H. (2023). Therapeutic uses of diuretic agents. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557838/
Herman, L. L., & Bashir, K. (2023). Hydrochlorothiazide. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430766/
Huxel, C., Raja, A., & Ollivierre-Lawrence, M. D. (2023). Loop diuretics. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK546656/
Khan, T. M., Patel, R., & Siddiqui, A. H. (2023). Furosemide. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499921/
Maren, T. H. (2023). Acetazolamide. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532282/
Merck Manual Professional Edition. (n.d.-a). Hypokalemia. Retrieved May 28, 2026, from https://www.merckmanuals.com/professional/nephrology/electrolyte-disorders/hypokalemia
MSD Manual Professional Edition. (2024). Hyperkalemia. https://www.msdmanuals.com/professional/nephrology/electrolyte-disorders/hyperkalemia
Patel, P. (2024). Chlorthalidone. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK553174/
Patel, P. (2024). Mannitol. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470392/
Patibandla, S., Heaton, J., & Kyaw, H. (2023). Spironolactone. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554421/
Sidhu, G., Puckett, Y., & Cassagnol, M. (2023). Bumetanide. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559181/
