Organic Nitrates

Question 1

The main organic nitrate is ——- termed as —– others like:
1-
2-
Indication of organic nitrates
1-
2-
3-
4-
5-

Answer 1

Glycerol trinitrate termed as nitroglycerin
1-isosorbide dinitrate 2-isosorbide 5-mononitrate

1- all forms of angina
2- MI
3- acute and chronic HF

Question 2

Best therapy for unstable angina or acute coronary syndrome?

Answer 2

Cardiac cath
Coronary artery bypass surgery

Question 3

Origin of nitrates
Mech of action of nitrates
Effect

Answer 3

Simple nitric and nitrouse esters of glycerol
Inc nitrite inc No inc cGMP activating cGMP kinase leading to dephos of myosin by MLC dephosphatase
Decrease in myocardial oxygen demand

Question 4

T or F
NO can dilate both arteries and veins but arteries dilation predominates

Answer 4

False
Venous predominates

Question 5

Effects of nitroglycerin:
1-
2-
3-

Answer 5

1-coronary artery dilation (dec resistance,inc flow,inc oxygen supply)
2-dec perioheral arterial resistance(dec BP)
3-dilation of large veins ( dec afterload dec preload and dec oxygen demand)

Question 6

Impirtant slide 12

Question 7

Adverse effects of nitroglycerin:
1-
2-
3-
4-
5-
6-
7-

Answer 7

Severe headache
Flushing
Dizziness
Postural hypertension
Reflex tachy
Methemoglobinemia can occur with chronic use of long term agents
Tolerance (can be overcome by providing a daily nitrate free interval to restore sensitivity to the drug)

Question 8

Contraindications of nitroglycerin:
1-
2-
Drug drug interaction

Answer 8

Nitrates are contraidicated with intracranial pressure
Obstructive cardiomyopathy (obstruction worsened by decrease preload)

Sildenafil and phosphodiesterase 5
(PDE5) inhibitors with nitrates can cause extreme hypotension

Question 9

Sodium nitroprusside:
Structure:
Indications:
1-
2-
3-

Answer 9

Nitroso group 5 cyanide and iron atom
1-Tx of hypertensive emergencies (during aortic dissection)
2-inc cardiac output during CHF associated with pulmonary edema
3-induce hypotension during anasthesia

Question 10

Mechanism of action of sodium nitroprusside:

Answer 10

On slide

Question 11

Pharmacokinetics of sodium nitroprusside:
Adm:
Onset of action:
Peak effect::
Effect dissapearance:

Answer 11

Adm: IV
Onset of act: within 30 sec
Peak: 2 min
Effect need 3 mins to disappear

Question 12

Contraindication:

Answer 12

Impaired renal and hepatic function which lead to inc cyanate toxicity leading to cyanide poisoning symptoms