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Renin together with angiotensin-converting enzyme produces angiotensin II, which is a powerful vasoconstrictor and stimulates the release of aldosterone from the adrenal glands. Figure shows the renin-angiotensin-aldosterone pathway. Vasoconstriction and the salt and water reabsorption activity of aldosterone result in restoration of blood volume and therefore blood pressure. In cardiac failure, cardiac output is reduced. This means initially that with exercise the organs and tissues do not have an adequate blood supply.
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Side effects are rare, but patients may get a dry mouth, urinary retention and constipation, all of which are typical effects of parasympathetic inhibition. High doses of antimuscarinic bronchodilators should not be used if the patient has glaucoma or an enlarged prostate gland, because they would make the glaucoma and urinary retention worse. Xanthines are a group of drugs that directly cause relaxation of bronchial smooth muscle and some central respiratory stimulation. They also have a slight diuretic effect.
Another type of deterioration is the shortening of action of each dose buy prochlorperazine time (end of dose deterioration) and unpredictable fluctuations in response to treatment, which can happen quite abruptly. It is not known why these effects occur, but they may be due to advance of the disease process. End of dose deterioration can be alleviated to a certain extent by the use of modified release preparations of levodopa or by the concurrent use of catechol-o-methyl transferase inhibitors, for example entacapone. COMT inhibitors prevent the peripheral breakdown of levodopa by an enzyme, COMT.
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This must be agreed with the patient before supplementary prescribing begins. Templates are available for CMPs, which can be adapted or individuals can develop their own.
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They may be formulated in this way because the active drug is difficult to administer, whereas the inactive prodrug does not cause the same complications, or because the active drug is not absorbed or distributed to its intended site of action easily. Most tissues in the body have the enzymes capable of metabolizing a variety of substances. However, as one of the main functions of the liver is the metabolism of toxic substances produced during normal metabolic processes, it is not surprising that the majority of drug metabolism takes place in the liver.
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Drugs taken orally are also subjected to these processes. The digestive system consists of the mouth, oesophagus, stomach, small intestine, large intestine, rectum and anus together with the liver and pancreas.
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Sulfonylureas work by stimulating remaining functional β-cells in the islets of the pancreas so that insulin is secreted in response to normal stimuli.
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