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Aminoglycoside Toxicity
The main concerns with the use of aminoglycoside antibiotics are nephrotoxicity and ototoxicity.
Nephrotoxicity is one of the most important side effects and therapeutical limitations of aminoglycoside antib iotics, especially
gentamicin.
Aminoglycosides
Nephrotoxicity induced by aminoglycosides manifests clinically as nonoliguric renal failure, with a slow rise in serum
creatinine and a hypoosmolar urinary output developing after several days of treatment.
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Nephrotoxicity: A wide variation in the incidence. Usually reversib le. Increase in serum creatinine and BUN. Ototoxicity: Cochlear
and vestib ular. Bilateral and permanent.
Aminoglycosides – Serum Peak and Trough
In view of reduced renal excretion, aminoglycosides require dosage modification in patients with renal failure.
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Regular monitoring of serum level and adjustment of doses accordingly is necessary, and this is particularly relevant in patients
undergoing continuous renal replacement therapy to maintain optimum b actericidal efficacy.
Amoxicillin (Amoxil)
Amoxil (amoxicillin) is a penicillin antibiotic. It fights bacteria in your body. It is used to treat many different types of
infections caused by bacteria, such as ear infections, bladder infections, pneumonia, gonorrhea, and E. coli or salmonella
infection.
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Amoxil is also sometimes used together with another antib iotic called clarithromycin (Biaxin) to treat stomach ulcers caused b y
Helicob acter pylori infection. This comb ination is sometimes used with a stomach acid reducer called lansoprazole (Prevacid).
Ancef and Kefzol (Cefazolin)
Cefazolin is a cephalosporin (SEF a low spor in) antibiotic. It works by fighting bacteria in your body. Cefazolin is used to
treat many kinds of bacterial infections, including severe or life-threatening forms.
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Cefazolin is a cephalosporin (SEF a low spor in) antib iotic. It works b y fighting b acteria in your b ody. Cefazolin is used to treat
many kinds of b acterial infections, including severe or life-threatening forms.
Metronidazole (Flagyl)
Metronidazole is an antibiotic. It fights bacteria in your body. Metronidazole is used to treat bacterial infections of the
vagina, stomach, skin, joints, and respiratory tract. This medication will not treat a vaginal yeast infection.
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This antib iotic only treats b acterial and protozoal infections. It will not work for viral infections (e.g. common cold, flu). Unnecessary
use or overuse of any antib iotic can lead to its decreased effectiveness.
Ciprofloxacin (Cipro)
Ciprofloxacin is an antibiotic in a group of drugs called fluoroquinolones (flor-o-KWIN-o-lones). It fights bacteria in the
body. It is also used to treat different types of bacterial infections.
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Cipro is also used to treat people who have b een exposed to anthrax.
Cephalosporins
Cephalosporins are a group of broad spectrum, semi-synthetic beta-lactam antibiotics derived from the mould
Cephalosporium. They are divided into three groups: Cephalosporin N and C are chemically related to penicillins and
Cephalosporin P a steroid antibiotic resembles fusidic acid.
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The mechanism of action of cephalosporins is the same as penicillins. They interfere with b acterial cell wall synthesis.
Antiretrovirals
This is the main type of treatment for HIV or AIDS. It is not a cure, but it can stop people from becoming ill for many
years. The treatment consists of drugs that have to be taken every day for the rest of someone’s life.
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Antiretroviral drugs are medications for the treatment of infection b y retroviruses, primarily HIV.
Antibiotic Tree
Antibiotics are powerful medicines that fight bacterial infections. Used properly, antibiotics can save lives. They either kill
bacteria or keep them from reproducing. Your body’s natural defenses can usually take it from there.
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If a virus is making you sick, taking antib iotics may do more harm than good. Each time you take antib iotics, you increase the
chances that b acteria in your b ody will b e ab le to resist them.
Isoniazid (INH)
Isoniazid is an antibiotic. It prevents tuberculous bacteria from multiplying in the body. Isoniazidis used to treat and to
prevent tuberculosis (TB).
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The mechanism of action of Isoniazid is not known, b ut it is thought to work through its effects on lipids (fats) and DNA within the
tub erculosis b acterium.
Clotrimazole (Lotrimin)
Clotrimazole topical is an antifungal antibiotic that fights infections caused by fungus. It is used to treat skin infections
such as athlete’s foot, jock itch, ringworm, and yeast infections.
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Lotrimin is used topically on the skin, inserted vaginally or allowed to dissolve in the mouth for local fungal infections.
Peak and Trough
Ideally, peak and trough levels are drawn after the patient has received at least three scheduled maintenance doses.
Exceptions may be made by the practitioner.
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Peak and trough levels are drawn after the patient has received at least three scheduled maintenance doses. Exceptions may b e
made b y the practitioner or pharmacist.
Penicillin (PCN)
Penicillin V is an antibiotic in the penicillin group of drugs. It fights bacteria in your body.Penicillin V is used to treat many
different types of infections caused by bacteria, such as ear infections.
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Today, many derivatives of penicillin have b een developed which inhib it more types of b acteria than the original, life-saving drug.
2 QTS Say No to OBs
Tetracyclines cause fetal tooth discoloration and inhibition of bone growth if used in the second and third
trimesters. Quinolones may cause arthropathies in children, and so are currently not recommended for use in pregnancy.
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The only antib iotics which may b e of concern in nursing infants are sulfonamides and quinolones, and possib ly metronidazole.
Respigam
Respiratory syncytial virus immune globulin (RSV IG) is a sterilized solution obtained from pooled human blood. It
contains the immunoglobulins (or antibodies) to protect against infection from respiratory syncytial virus (RSV), a virus
that can cause serious illness in children.
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RSV IG is used to help prevent or reduce the severity of lower respiratory tract (lung) disease caused b y respiratory syncytial virus in
children who are at increased risk.
Rocephin
Rocephin (ceftriaxone) is a cephalosporin (SEF a low spor in) antibiotic. It works by fighting bacteria in your
body. Rocephin is used to treat many kinds of bacterial infections, including severe or life-threatening forms such as
meningitis.
To reduce the development of drug-resistant b acteria and maintain the effectiveness of Rocephin (ceftriaxone) and other
antib acterial drugs, Rocephin (ceftriaxone) should b e used only to treat or prevent infections that are proven or strongly suspected
to b e caused b y b acteria.
Tequin (Gatifloxacin)
Tequin is an antibiotic in a group of drugs called fluoroquinolones. It fights bacteria in the body.Tequin is used to treat
bacterial infections of the lungs, sinuses, skin, and urinary tract. It is also used to treat certain sexually transmitted
diseases.
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Do not give this drug to Diab etic patients.
Tetracycline Uses
Tetracycline, is used to treat bacterial infections, including pneumonia and other respiratory tract infections; acne;
infections of skin, genital and urinary systems; and the infection that causes stomach ulcers (Helicobacter pylori). It also
may be used as an alternative to other medications for the treatment of Lyme disease and for the treatment and
prevention of anthrax (after inhalational exposure).
Tetracycline is in a class of medications called tetracycline antib iotics. It works b y preventing the growth and spread of b acteria.
Antib iotics will not work for colds, flu, or other viral infections.
Azithromycin (Zithromax)
Azithromycin is used to treat certain bacterial infections, such as bronchitis; pneumonia; sexually transmitted diseases
(STD); and infections of the ears, lungs, sinuses, skin, throat, and reproductive organs. Azithromycin also is used to treat
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people with human immunodeficiency virus (HIV)].
Azithromycin is in a class of medications called macrolide antib iotics. It works b y stopping the growth of b acteria. Antib iotics will not
kill viruses that can cause colds, flu, or other infections.
Antifibrinolytics
Antifibrinolytics are used in menorrhagia and bleeding tendency due to various causes. Their application may be beneficial
in patients with hyperfibrinolysis because they arrest bleeding rapidly if the other components of the haemostatic system
are not severely affected. This may help to avoid the use of blood products such as fresh frozen plasma (FFP) with its
associated risks of infections or anaphylactic reactions.
These drugs b lock the b inding sites of the enzymes or plasminogen respectively and thus stop plasmin formation.
Warfarin Sodium (Coumadin)
Coumadin is a prescription medicine used to treat blood clots and to lower the chance of blood clots forming in your body.
Blood clots can cause a stroke, heart attack, or other serious conditions if they form in the legs or lungs.
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To help warfarin (Coumadin) work effectively, it is important to keep your vitamin K intake as consistent as possib le. Sudden
increases in vitamin K intake may decrease the effect of warfarin (Coumadin). On the other hand, greatly lowering your vitamin K
intake could increase the effect of warfarin (Coumadin).
Heparin
Heparin is an anticoagulant (blood thinner) that prevents the formation of blood clots. Heparin is used to treat and prevent
blood clots in the veins, arteries, or lung.
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Heparin is also used b efore surgery to reduce the risk of b lood clots.
Heparin – Coumadin (Responding Lab Tests)
Partial thromboplastin time (PTT) and activated partial thromboplastin time (aPTT) are used to test for the same
functions; however, in aPTT, an activator is added that speeds up the clotting time and results in a narrower reference
range. The aPTT is considered a more sensitive version of the PTT and is used to monitor the patient’s response to
heparin therapy.
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The reference range of the aPTT is 30-40 seconds. The reference range of the PTT is 60-70 seconds. Critical values that should
prompt a clinical alert are as follows: aPTT: More than 70 seconds (signifies spontaneous b leeding) PTT: More than 100 seconds
(signifies spontaneous b leeding)
Albumin
Albumin helps move many small molecules through the blood, including bilirubin, calcium, progesterone, and medications.
It plays an important role in keeping the fluid from the blood from leaking out into the tissues.
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Alb umin is used in the treatment of shock, b urns or low b lood protein to temporarily correct or prevent a b lood volume deficiency.
Iron Supplements
Iron supplements are dietary supplements containing iron that can be prescribed by a doctor for a medical reason, or
purchased from a vitamin shop, drug store etc. They are primarily used to treat anemia or other iron deficiencies.
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The patient may notice that his/her stools b ecome b lack. This is completely harmless, b ut patients must b e warned ab out this to
avoid unnecessary concern. When iron supplements are given in a liquid form, teeth may reversib ly discolor (this can b e avoided
through the use of a straw). Intramuscular injection can b e painful, and b rown discoloration may b e noticed.
Clopidogrel (Plavix)
Clopidogrel is used to prevent heart attacks and strokes in persons with heart disease (recent heart attack), recent stroke,
or blood circulation disease (peripheral vascular disease). It is also used with aspirin to treat new/worsening chest pain
(new heart attack, unstable angina) and to keep blood vessels open and prevent blood clots after certain procedures (such
as cardiac stent). It works by blocking certain blood cells called platelets and prevents them from forming harmful blood
clots. This “anti-platelet” effect helps keep blood flowing smoothly in your body.
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It might take longer than normal to stop b leeding if you cut yourself while taking clopidogrel.
Epoetin Alfa (Procrit)
Epoetin alfa injection is used to treat anemia (a lower than normal number of red blood cells) in people with chronic kidney
failure (condition in which the kidneys slowly and permanently stop working over a period of time). Epoetin alfa injection
is also used to treat anemia caused by chemotherapy in people with certain types of cancer or caused by zidovudine
(AZT, Retrovir, in Trizivir, in Combivir), a medication used to treat human immunodeficiency virus (HIV). Epoetin alfa
injection is also used before and after certain types of surgery to decrease the chance that blood transfusions (transfer of
one person’s blood to another person’s body) will be needed because of blood loss during surgery.
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Epoetin alfa is in a class of medications called erythropoiesis-stimulating agents (ESAs). It works b y causing the b one marrow (soft
tissue inside the b ones where b lood is made) to make more red b lood cells.
Thrombolytics
Thrombolytic medications are approved for the immediate treatment of stroke and heart attack. The most commonly used
drug for thrombolytic therapy is tissue plasminogen activator (tPA), but other drugs can do the same thing.
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Thromb olytics work b y dissolving a major clot quickly. This helps restart b lood flow to the heart and helps prevent damage to the
heart muscle. Thromb olytics can stop a heart attack that would otherwise b e deadly.
Anticancer Drugs
The available anticancer drugs have distinct mechanisms of action which may vary in their effects on different types of
normal and cancer cells. A single “cure” for cancer has proved elusive since there is not a single type of cancer but as
many as 100 different types of cancer. In addition, there are very few demonstrable biochemical differences between
cancerous cells and normal cells. For this reason the effectiveness of many anticancer drugs is limited by their toxicity to
normal rapidly growing cells in the intestinal and bone marrow areas. A final problem is that cancerous cells which are
initially suppressed by a specific drug may develop a resistance to that drug. For this reason cancer chemotherapy may
consist of using several drugs in combination for varying lengths of time.
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Chemotherapy drugs, are sometimes feared b ecause of a patient’s concern ab out toxic effects. Their role is to slow and hopefully
halt the growth and spread of a cancer.
Leukeran (Chlorambucil)
Chlorambucil is a chemotherapy drug that has been mainly used in the treatment of chronic lymphocytic leukemia. It is
a nitrogen mustard alkylating agent and can be given orally. current use is mainly in chronic lymphocytic leukemia, as it is
well tolerated by most patients, though chlorambucil has been largely replaced by fludarabine as first-line treatment in
younger patients.
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Bone marrow suppression (anemia, neutropenia, thromb ocytopenia) is the most commonly occurring side effect of chloramb ucil.
Withdrawn from the drug, this side effect is typically reversib le. Like many alkylating agents, chloramb ucil has b een associated with
the development of other forms of cancer.
ACE Inhibitors
Angiotensin-converting enzyme (ACE) inhibitors help relax blood vessels. ACE inhibitors prevent an enzyme in your body
from producing angiotensin II, a substance in your body that affects your cardiovascular system by narrowing your blood
vessels and releasing hormones that can raise your blood pressure. This narrowing can cause high blood pressure and
force your heart to work harder.
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ACE inhib itors are used for controlling high b lood pressure, treating heart failure, preventing strokes, and preventing kidney
damage in people with hypertension or diab etes. They also improve survival after heart attacks.
ACE Inhibitors 2
ACE inhibitors are used to treat heart disease. These medicines make your heart work less hard by lowering your blood
pressure. This keeps some kinds of heart disease from getting worse. Most people who have heart failure take these
medicines.
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They also are used to treat diab etes and kidney prob lems. This can help keep your kidneys from getting worse.
Adrenergic Antagonists (Alpha-Blockers)
Alpha-blockers are medicines that are mainly used to treat hypertension (high blood pressure), and problems with passing
urine in men who have enlargement of the prostate gland. If you have hypertension – alpha-blockers are usually
prescribed after most other medicines have been tried. If you have problems passing urine (because of an enlarged
prostate), the decision to start alpha-blockers depends on how much you are bothered by the symptoms. Side-effects are
uncommon (slight drowsiness, headaches, and dizziness). They are more likely to occur in the first two weeks of
treatment, and usually go away on their own.
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Although side-effects are uncommon, they occur in some people. Side-effects are more likely to occur in the first two weeks of
treatment, and usually go away on their own. The most common side-effects are slight drowsiness, headaches and dizziness. If you
are prescrib ed an alpha-b locker, read the leaflet that comes with the medicine packet for a full list of possib le side-effects and
cautions.
Adrenergic Antagonists (Beta-Blockers)
Beta-blockers are medicines that are used to treat various conditions including angina, high blood pressure, some abnormal
heart rhythms, heart failure, myocardial infarction (heart attack), anxiety, overactive thyroid symptoms, glaucoma and
migraine.
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Most people who take b eta-b lockers have no side-effects, or only minor ones. However, b ecause of their action in various parts of
the b ody, some people have unwanted side-effects such as the heart rate can go too slowly, Tiredness, depression, impotence.
Antiarrhythmics
Antiarrhythmic agents are pharmaceuticals used to combat cardiac arrhythmias. An arrhythmia is an abnormality of the
rate or rhythm of the heartbeat, such as atrial fibrillation, atrial flutter, ventricular fibrillation and ventricular tachycardia.
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These drugs only control ab normal heart rhythms, not cure them.
Antihypertensives
Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke and myocardial
infarction.
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Although b eta b lockers lower b lood pressure, they do not have a positive b enefit on endpoints as some other antihypertensives.
Antihypertensives 2
There are many classes of antihypertensives, which lower blood pressure by different means; among the most important
and most widely used are the thiazide diuretics, the ACE inhibitors, the calcium channel blockers, the beta blockers, and
the angiotensin II receptor antagonists or ARBs.
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Among the most important and most widely used antihypertensive drugs are the thiazide diuretics, the ACE inhib itors, the calcium
channel b lockers, the b eta b lockers, and the angiotensin II receptor antagonists or ARBs.
Beta-1 and Beta-2 Blockers
When referring to beta 1 and beta 2 blockers, It is not the blockers that are 1 and 2, but the receptors they are blocking.
There are actually three types of beta receptors. Beta 1 receptors are found in the heart and brain. Beta 2 receptors are
found in the gastrointestinal tract, uterus, vascular smooth muscles, lungs, and skeletal muscles. Beta 3 receptors are
found in fat cells.
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Cardioselective b eta b lockers (b eta1- selective b lockers) have a clinical advantage in that they mainly affect the heart, which
predominantly has b eta1 receptors. The effect of b roncho-constriction is less with b eta1 selective b lockers, as the b ronchial muscle
has more b eta2 receptors, however the danger of b roncho-constriction cannot b e totally ignored, as they are not totally selective.
Beta Blockers
Beta blockers, also known as beta-adrenergic blocking agents, are a class of drugs that works by blocking the
neurotransmitters norepinephrine and epinephrine from binding to receptors. There are three known types of beta
receptors, known as beta1 (β1 ), beta2 (β2 ) and beta3 (β3 ).
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When the neurotransmitters are prevented from b inding to the receptors, it in turn causes the effects of adrenaline (epinephrine) to
b e b locked. This action allows the heart to relax and b eat more slowly thereb y reducing the amount of b lood that the heart must
pump. Over time, this action improves the pumping mechanism of the heart.
Calcium Antagonists
Calcium antagonist-based regimen is superior to other regimens in preventing stroke, equivalent in preventing ischemic
heart disease, and inferior in preventing congestive heart failure. Calcium antagonists are also safe and effective as firstline or add-on therapy in diabetic hypertensive patients. Heart rate-lowering calcium antagonists (verapamil, diltiazem)
may have an edge over the dihydropyridines in post-myocardial infarction patients and in diabetic nephropathy. Thus,
calcium antagonists may be safely used in the management of hypertension and angina pectoris.
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In several comparative studies in hypertensive patients, treatment with calcium antagonists was equally effective as treatment with
diuretics, b eta-b lockers, or angiotensin-converting enzyme inhib itors.
Cordarone (Amiodarone)
Amiodarone belongs to the family of medications known as antiarrhythmics. It is used to treat certain types of abnormal
heart rhythms (arrhythmias). It works by changing how electrical impulses affect the heart muscle and by making the
heart beat more regularly.
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The effects of this medication may b e noted as early as 3 days after starting treatment, b ut it is usually 1 to 3 weeks b efore
b eneficial effects are seen.
Digitalis
Digitalis medication works directly on the heart muscle to strengthen and regulate the heartbeat. It is used to treat certain
heart conditions.
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Diarrhea, loss of appetite, drowsiness, headache, muscle weakness, and fatigue may occur as the b ody adjusts to the medication.
Drugs for Bradycardia and Low Blood Pressure
Use IDEA to treat bradycardia and hypotension.
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I – Isoproterenol, D – Dopamine, E – Epinephrine, A – Atropine
Emergency Drugs
Remember LEAN for emergency drugs.
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L – Lidocaine, E – Epinephrine, A – Atropine, N – Narcan
Lidocaine Toxicity
Overdosage with lidocaine can be a result of excessive administration via topical or parenteral routes, accidental oral
ingestion of topical preparations by children, accidental intravenous (rather than subcutaneous, intrathecal or paracervical)
injection or prolonged use of subcutaneous infiltration anesthesia during cosmetic surgical procedures. These occurrences
have often led to severe toxicity or death in both children and adults.
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Lidocaine easily crosses from the b lood to the b rain, so, if an overdose has occurred, the following symptoms will prob ab ly show up
first: headache, tinnitus (ringing in the ears), facial twitches, lightheadedness, a metallic taste, and numb ness of the lips and tongue.
In higher doses, there may also b e seizures, unconsciousness, apnea, and CV collapse. At the highest doses, heart failure occurs.
Focinopril (Monopril)
Fosinopril is an angiotensin converting enzyme (ACE) inhibitor used for the treatment of hypertension and some types of
chronic heart failure. Fosinopril is the only phosphinate-containing ACE inhibitor marketed. It is marketed by BristolMyers Squibb under the trade name Monopril.
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Monopril works b y decreasing certain chemicals that tighten the b lood vessels, so b lood flows more smoothly and the heart can
pump b lood more efficiently.
Nitroglycerin
Nitroglycerin spray and tablets are used to treat episodes of angina (chest pain) in people who have coronary artery
disease (narrowing of the blood vessels that supply blood to the heart). The spray and tablets may also be taken just
before activities that may cause episodes of angina in order to prevent the angina from occurring. Nitroglycerin extendedrelease (long-acting) capsules are used to prevent episodes of angina in people who have coronary artery disease. The
extended-release capsules can only be used to prevent angina attacks; they cannot be used to treat an attack once it has
begun. Nitroglycerin is in a class of medications called vasodilators.
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Nitroglycerin works b y relaxing the b lood vessels so the heart does not need to work as hard and therefore does not need as much
oxygen.
Spironolactone (Aldactone)
Spironolactone is a potassium-sparing diuretic (water pill) that prevents your body from absorbing too much salt and keeps
your potassium levels from getting too low.
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Spironolactone also treats fluid retention (edema) in people with congestive heart failure, cirrhosis of the liver, or a kidney disorder
called nephrotic syndrome. This medication is also used to treat or prevent hypokalemia (low potassium levels in the b lood).
Bumetanide Bumex
Bumetanide is a potent diuretic (water pill) that causes a profound increase in urine output (diuresis) by preventing the
kidney from retaining fluid. Specifically, it blocks the reabsorption of sodium and fluid from the kidney’s tubules. It is in a
class of diuretics called “loop” diuretics which also includes furosemide (Lasix) and torsemide (Demadex).
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Bumetanide is a very potent medication. Using too much of this drug can lead to serious water and salt/mineral loss.
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