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Heiman.pharm.vascev7

Nitrates

QuestionAnswer
Mechanism Stimulation of intracellular cyclic guanosine monophosphate (cGMP) production Leads to dilatation of the venous bed which decreases venous return
Mechansim cont'd Reduced preload results in reduced filling pressure which reduces myocardial wall tension decreasing oxygen demand Some dilatation of coronary arteries
Kinetics Variable first past effect Short half-life Liver metabolism Rapid clearance
Cautions Watch for postural hypotension Use with caution in patients with open-angle glaucoma Sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra)‏ May cause severe hypotension
Adverse Effects Headache Flushing Nausea/vomiting Tachycardia Hypotension Syncope Rash Blurred vision
Names Nitroglycerin Isosorbide dinitrate Isordil – sublingual and oral Dilatrate SR Isosorbide mononitrate Imdur - sustained release Monoket, ISMO All should be taken on an empty stomach
Nitrates Tolerance Tolerance to effects develops with continuous use Need a nitrate free period of 8 – 12 hours every day Usually done overnight If angina is more at night or very early in the morning this can be switched around
Created by: DianaB
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