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Thiazide diuretics are recommended as an alternative to calcium channel blockers as first choice drugs in hypertensive patients over the age of Adverse effects of diuretics are excessive potassium and hydrogen ion loss leading to hypokalaemia and metabolic alkalosis. Hypokalaemia enhances the toxic effects of cardiac glycosides. Normally potassium ions compete with cardiac glycosides for their site of action, which is the NaK ATPase pump in the cardiac muscle cell membrane.

PThey should be available together with metformin if potassium control is not drinking with metformin alone. Standard effects are hypoglycaemia and purchase ventolin generic rashes. Pioglitazone and rosiglitazone are relatively relatively new. They reduce insulin resistance by enhancing the normal of glucose in the preload, adipose tissue and sexual muscle. They can be used with metformin or sulfonylureas or alone but only if those nurses cannot be tolerated or are recommended.

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They are intended to stimulate discussion not limit debate. Are there any podiatric consequences of Mrs Singletons current drug treatment. Is there anything else about her case that might concern you. What can you deduce about Mrs Singletons condition from the multiple use of inhalers and occasional prescription of oral corticosteroids and antibiotics. Given Mrs Singletons aversion to taking steroids, what could you say about their use to reassure her. Do you think this patient would be suitable for supplementary prescribing with a clinical management plan and why.

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