Lecture Notes on Nitrates

Introduction to Nitrates

• Common names and prefixes: "nit" (e.g., Nitroglycerin)
  • Trade names: Nitrostat, Nitrobed
  • Isosorbide mononitrate: Brand name Imadur
• Function: Vasodilators
  • Vaso: Related to vessels
  • Dilate: To enlarge or make bigger

Mechanism of Action

• Nitrates open blood vessels
• Target condition: Atherosclerosis (fatty plaque buildup)
  • Occlusion leads to reduced blood flow, causing chest pain (angina)
• Effect: Increase blood flow, alleviate chest pain

Therapeutic Uses

• Treatment and prevention of angina (acute chest pain)
  • Caused by constricted/block vessels to the heart
• Treatment of acute coronary syndrome
  • Sudden blockage leads to ischemia
• Overall: Enables activities without chest pain

Side Effects ("H's of Nitrates")

• Headache
• Hot flushed face
• Hypotension (low blood pressure)

Routes of Administration

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

Patient Education

Topical/Transdermal Applications

• Remove prior doses before applying new
• Rotate site, use hair-free and clean area
• Do not touch/rub into skin (prevents rapid absorption and severe headache)

Sublingual and Buccal Administration

• Do not swallow or chew
• Sublingual: Place under tongue
• Buccal: Place between cheek and gum
• Store in original container (dark glass bottle), dry and cool
• Keep with patient at all times for emergency use

Contraindications

• Avoid with phosphodiesterase inhibitors (erectile dysfunction drugs, e.g., Viagra)
  • Risk of severe hypotension and death
• Avoid in patients with increased intracranial pressure (ICP)

Key Takeaways

• Nitrates dilate vessels, increasing blood/oxygen delivery
• Used for angina and acute chest pain prevention/treatment
• Stored properly in original container
• Topical forms should not be rubbed in
• Avoid combination with phosphodiesterase inhibitors due to severe risks

• For additional pharmacology information, refer to complete pharmacology flashcards.
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Happy studying, future nurses!