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By Bernard R. Jones

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100 plus, down to 70, but each contraction of the left ventricle will now be sending out a more powerful supply of CARDIOVASCULAR DRUGS 45 blood, and back pressure on the right side will be eased by the more prolonged and complete filling of the right atrium. The more efficient circulation will mobilise and take up surplus tissue fluid and reduce oedema; this will be helped also by a higher urinary output. The distress of wet and oedematous lungs is similarly eased, and breathing improved. The value of additional diuretic therapy in relieving oedema is mentioned on page 28.

Daily, then increasing to a maintenance level in the order of 240 mg. daily, usually in four divided doses. The value of diuretics must again be stressed in the case of hyper­ tension. g. chlorothiazide, for which some actual effect on blood-vessel wall relaxation is also claimed. The benefit of increased diuresis lies in the fact that it lowers the degree of fluid tension in the body tissues; this, in turn, eases the pressure load on the circulating blood. g. to the point of fainting; this is a decided advantage, because reduction of dosage leads to a similar reduction of side-eff'ects, such as the distressing diarrhoea referred to earlier.

Ethacrynic Acid—'Edecrin'— „ „ 50 mg. also I/V — „ „ 50 mg. DIURETICS 29 Other oral diuretics are Chlorthalidone and Triamterene, in tablet and capsule form respectively. Chlorthalidone has prolonged effect, and dosage on aUernate days or twice weekly is normally sufficient; triamterene is milder in action, but has no effect on potassium loss and is thus useful in combination with other powerful diuretics. Chlorthalidone—'Hygroton'—av. dose 100 mg. Triamterene —'Dytac' — „ „ 50 mg. Spironolactone Occasionally, diuretics of the thiazide type fail to produce the required output of urine, for the fohowing reason.

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