Nitrates

Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton  

Introduction[edit | edit source]

Nitrates are a class of medications that cause vasodilation. Nitrates exert their effects by dilating venous vessels, coronary arteries, and small arterioles; its maximal vasodilation is in the venous vessels.

  1. Nitrates are primarily indicated for the treatment of angina, where preferential venodilation causes pooling of blood, decreased preload, and ultimately decreased myocardial O2 demand.
  2. At high doses, nitrates can decrease afterload and may be used in hypertensive crises. The main adverse effects include headache, hypotension, and reflex tachycardia[1][2].

Indications[edit | edit source]

The type of nitrates used and the administration route differs depending on the type of cardiovascular disease. The use of nitrates is indicated in the following cardiovascular diseases: angina pectoris, acute coronary syndrome, arterial hypertension, and heart failure. The main types of nitrates are as followed:

  1. Nitroglycerin (NTG): angina pectoris (treatment/prophylaxis), acute coronary syndrome, heart failure, hypertension. Various administration routes: Sublingual tablet; Transdermal patch; Ointment; Capsule; Spray; or IV
  2. Isosorbide mononitrate (ISMN): chronic angina pectoris (treatment) Administration: Tablet; Sublingual tablet; or Spray
  3. Isosorbide dinitrate (ISDN): angina pectoris (treatment/prophylaxis) Administration: Tablet or Tablet (Sustained release)[1].

Types[edit | edit source]

  1. Short-acting nitrate preparations: eg Glyceryl trinitrate (GTN) tablets or sprays are commonly used to ease angina pains.
  2. Long-acting nitrate preparations: A long-acting preparation takes longer to start working, so is not much use for immediate pain relief. But, it works for much longer after each dose than a short-acting preparation (which loses its effect after 20 minutes or so).

Side Effects[edit | edit source]

Common side-effects include:

  • A throbbing headache.
  • A flushed face.
  • Dizziness.
  • Lightheadedness (from the nitrate causing low blood pressure).
  • Feeling slightly nauseous.
  • With the spray under the tongue: a slight burning or tingling sensation under the tongue[3].

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Resources[edit | edit source]

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References[edit | edit source]

  1. 1.0 1.1 Lee PM, Gerriets V. Nitrates. InStatPearls [Internet] 2021 Jul 13. StatPearls Publishing.Available: https://www.ncbi.nlm.nih.gov/books/NBK545149/(accessed 7.4.2022)
  2. Lecturio Nitrates Available:https://www.lecturio.com/concepts/nitrates/ (accessed 7.4.2022)
  3. Patient Info Nitrate medication Available;https://patient.info/heart-health/nitrate-medication (accessed 7.4.2022)