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CV PHARM...Antianginal > Nitrates > Flashcards

Flashcards in Nitrates Deck (7)
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1

MOA

organic nitrate ester reductase
-->NO-->GC-->cGMP-->PKG-->SM relaxation

Decreases demand and increases supply!

increase NO
--vasodilates-->
decreases afterload

--venodilates-->
decreases preload
(so decreases contractility via Frank-Starling)

2

CV effects

decreased preload
coronary vasodilation
(prevents or reverses vasospasm)

BP: unchanged/slight decrease
HR: unchanged or slight increase
Pulmonary vascular resistance: decreased
CO: reduced (slightly)

3

Preparations

mucosal
--sublingual
--nasal sprays

oral

transdermal

paste

IV

4

adverse effects

High doses...
--extreme vasodilation
....hypotension
....reflexive increase in HR and contractility
(worsens angina!!!)

transient headache
(meningeal arteries dilated until tolerance)

rash

***Drug interaction***
--Sildenafil (Viagra) [Type 5 PDE inhibitors]
(increases cGMP by decreasing metabolism)

5

pharmacokinetics

Rapidly metabolized (short-lived)

ok and beneficial for exertional angina
--can take it when they need it

challenge for others

6

Problem w/ continuous Nitrate exposure

tolerance

(avoided by "nitrate free" interval each day... i.e. remove patch at night)

7

Anginal rebound

Do Not suddenly interrupt IV nitroglycerin in unstable angina...overlap w/ oral or patch form

(coronary vasospasm has been observed after abrupt stop)