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Questions and Answers
What is the primary mechanism of action of nitrates in the treatment of cardiac conditions?
What is the primary mechanism of action of nitrates in the treatment of cardiac conditions?
Which of the following side effects is considered common and expected with nitrate use?
Which of the following side effects is considered common and expected with nitrate use?
What effect does nitrates have on cardiac oxygen demand?
What effect does nitrates have on cardiac oxygen demand?
Which of the following would be a contraindication for using nitrates?
Which of the following would be a contraindication for using nitrates?
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What should be checked prior to administering nitrates to a patient?
What should be checked prior to administering nitrates to a patient?
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What can occur when nitrates are combined with sildenafil?
What can occur when nitrates are combined with sildenafil?
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How can tolerance to nitrates manifest in long-term users?
How can tolerance to nitrates manifest in long-term users?
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What is the primary clinical use of short-acting nitrate forms?
What is the primary clinical use of short-acting nitrate forms?
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What is the effect of nitrates on afterload at high doses?
What is the effect of nitrates on afterload at high doses?
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What precaution should be advised to patients taking nitrates to prevent orthostatic hypotension?
What precaution should be advised to patients taking nitrates to prevent orthostatic hypotension?
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Study Notes
Nitrates - Drug Information
- Drug Names: Nitroglycerin, Isosorbide mononitrate, Isosorbide dinitrate
Mechanism of Action
- Vasodilator: Nitrates are vasodilators, meaning they widen blood vessels.
- Venous Dilation Predominant: Nitrates primarily dilate veins, which significantly reduces preload (the amount of blood in the heart before contraction).
- Arterial Dilation at High Doses: At higher doses, nitrates also dilate arteries, slightly reducing afterload (the resistance the heart must pump against).
- Coronary Artery Dilation: Nitrates dilate coronary arteries, increasing oxygen and blood supply to the heart.
- Reduced Cardiac Workload: This action decreases the heart's oxygen demand and workload.
Clinical Uses
- Angina and MI Treatment: Used to treat angina (chest pain) and myocardial infarction (heart attack).
- Chronic Stable Angina Prevention: Long-acting forms (patches, ointments) are used for preventing chronic stable angina.
- Acute Angina Treatment: Short-acting forms (sublingual tablets, sprays) treat acute angina attacks.
- Chronic Heart Failure Management: Some nitrates are also used to treat chronic heart failure.
Side Effects
- Headache: A common, expected side effect, usually not a reason to stop medication. Relieved with acetaminophen, and often subsides over time. Contraindicated in head trauma.
- Hypotension: Vasodilation can lead to low blood pressure. Blood pressure must be checked before each dose and administration is contraindicated if the patient is hypotensive.
- Contraindicated with Sildenafil: Combining nitrates with PDE5 inhibitors (like sildenafil, used for erectile dysfunction) can cause dangerously low blood pressure.
- Orthostatic Hypotension: Dizziness related to blood pressure drop when changing positions. Patient should remain seated or lying down when taking the medication, and advised to slowly change positions.
- Reflex Tachycardia: Increased heart rate in response to reduced blood pressure.
- Tolerance: Long-term use can lead to the body becoming less responsive to the medication.
- Flushing: Facial flushing due to vasodilation.
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Description
This quiz covers the pharmacology of nitrates, including drug names like Nitroglycerin and Isosorbide mononitrate. It focuses on their mechanism of action as vasodilators predominantly affecting veins, as well as their clinical applications in treating angina and myocardial infarction. Test your knowledge on how these medications work and their therapeutic benefits.
