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.
- Nitrates are primarily indicated for the treatment of angina, where preferential venodilation causes pooling of blood, decreased preload, and ultimately decreased myocardial O2 demand.
- 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:
- Nitroglycerin (NTG): angina pectoris (treatment/prophylaxis), acute coronary syndrome, heart failure, hypertension. Various administration routes: Sublingual tablet; Transdermal patch; Ointment; Capsule; Spray; or IV
- Isosorbide mononitrate (ISMN): chronic angina pectoris (treatment) Administration: Tablet; Sublingual tablet; or Spray
- Isosorbide dinitrate (ISDN): angina pectoris (treatment/prophylaxis) Administration: Tablet or Tablet (Sustained release)[1].
Types[edit | edit source]
- Short-acting nitrate preparations: eg Glyceryl trinitrate (GTN) tablets or sprays are commonly used to ease angina pains.
- 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].
Do Nitrates lower blood pressure?[edit | edit source]
A 2015 study suggests the nitrates in many vegetables may keep blood vessels healthy and lower blood pressure. Previous studies have shown that a diet rich in fruits and vegetables, such as the Dietary Approaches to Stop HypertensionHypertension (DASH) diet, can reduce blood pressure.[4]
Foods to boost your nitric oxide levels include: Beets, rich in dietary nitrates, which your body can convert to nitric oxide; Garlic; Dark Chocolate; Leafy Greens; Citrus Fruits; Pomegranate; Nuts and Seeds[5].
Physiotherapy Relevance[edit | edit source]
Nitrates Clinical relevance when exercising
- For acute use; hypotension and reflex tachycardia are common Monitor HR and BP.
- Prophlactic treatment; Monitor symptoms of hypotension, tachycardia and angina[6]
References[edit | edit source]
- ↑ 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)
- ↑ Lecturio Nitrates Available:https://www.lecturio.com/concepts/nitrates/ (accessed 7.4.2022)
- ↑ Patient Info Nitrate medication Available;https://patient.info/heart-health/nitrate-medication (accessed 7.4.2022)
- ↑ Kapil V, Khambata RS, Robertson A, Caulfield MJ, Ahluwalia A. Dietary nitrate provides sustained blood pressure lowering in hypertensive patients: a randomized, phase 2, double-blind, placebo-controlled study. Hypertension. 2015 Feb;65(2):320-7. Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4288952/ (accessed 7.4.2022)
- ↑ Ask a lot of questions What drugs are considered nitrates? Available:https://askinglot.com/what-drugs-are-considered-nitrates (accessed 7.4.2022)
- ↑ Heart Online Exercise response to cardiac medications Available: https://www.heartonline.org.au/media/DRL/Exercise_response_to_cardiac_medications.pdf (accessed 7.4.2022)