Lecture on Nitrates

Nitrate Medications

• Common Names:
  • Nitroglycerin (Trade names: Nitrostat, Nitrobed)
  • Isosorbide Mononitrate (Brand name: Imadur)

Mechanism of Action

• Nitrates as Vasodilators:
  • "Vaso" relates to blood vessels.
  • "Dilate" means to enlarge or open up.
  • Nitrates help open blood vessels.
• Action in Atherosclerosis:
  • Atherosclerosis: fatty plaque buildup in vessels.
  • Leads to decreased blood flow to the heart.
  • Causes chest pain (angina).
  • Nitrates dilate vessels, increase blood flow, reducing pain.

Therapeutic Uses

• Treatment & Prevention of:
  • Angina (acute chest pain)
  • Acute coronary syndrome (sudden blood flow blockage leading to ischemia)

Side Effects

• Remember the H's:
  • Headache
  • Hot flushed face
  • Hypotension
  • Caused by rapid blood flow and dilation.

Routes of Administration

• Quick Onset:
  • Intravenous (IV)
  • Sublingual tablets (under the tongue)
  • Buccal tablets (between cheek and gums)
  • Oral spray
• Slower Onset:
  • Nitro patch
  • Topical ointment
  • Sustained-released tablets

Patient Education

Topical/Transdermal Applications

• Remove prior doses before applying new.
• Rotate application sites.
• Apply on hair-free, clean areas.
• Avoid touching/rubbing into skin to prevent severe headache.

Sublingual/Buccal Administration

• Do not swallow or chew.
• Sublingual: place under the tongue.
• Buccal: place between cheek and gum.
• Keep in original container (dark glass bottle) in a dry, cool place.
• Medication should be kept with patient at all times.

Contraindications

• Interactions to Avoid:
  • Phosphodiesterase inhibitors (erectile dysfunction drugs, e.g., sildenafil/Viagra).
  • Risk of severe hypotension, potentially fatal.
• Avoid in patients with increased intracranial pressure.

Key Takeaways

• Nitrates open vessels, increase blood/oxygen flow.
• Used for angina treatment/prevention.
• Store properly to avoid degradation.
• Phosphodiesterase inhibitors are contraindicated.

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