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They seem to increase glucose uptake by peripheral muscle cells and reduce gluconeogenesis and intestinal glucose absorption. Only one, metformin, is available in the United Kingdom. It does not stimulate appetite and therefore is useful in obese patients. Metformin also reduces plasma concentrations of cholesterol [in the form of low density lipoproteins], which could help reduce the risk of atheroma, and it is unlikely to cause hypoglycaemia. It can be lady era pills buy with sulfonylureas.

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They may cause abdominal cramps. Examples of osmotic laxatives used prior to imaging are magnesium citrate and magnesium sulphate. Lactulose is a disaccharide with a similar action. Polyethylene glycol is an osmotic laxative used for bowel cleansing (see below). Although only small amounts of these drugs are absorbed, osmotic laxatives should not be used in patients with poor renal function because of the risk of magnesium accumulation.

An example is valsartan. This is a relatively new group of drugs and adverse effects appear to be rare. They provide an alternative for those who cannot tolerate ACE inhibitors because of a persistent dry cough, but should not be used in pregnancy either. Neither ACE inhibitors nor angiotensin II receptor inhibitors seem to benefit patients of African origin. Nitrates are used primarily to treat ischaemic heart disease.

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Glyceryl trinitrate is extremely effective at relieving the pain of angina but it has only a short half-life. Due to extensive first pass metabolism the drug is ineffective when taken orally and is administered sublingually or buccally in either tablet or aerosol form. Sustained release forms are available to provide prophylactic action against angina attacks; these are formulated into transdermal patches. Isosorbide dinitrate and isosorbide mononitrate are more stable forms of nitrate and have a longer lasting lady era pills buy than GTN making them more suitable for prophylaxis of angina.

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