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Nitrates – Angina and Heart Failure Management

by Pravin Shukle, MD
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    Let's talk about nitrates. There are many kinds of nitrates. They start off with amyl nitrate. We also talk about sublingual nitrate or NitroTabs. We talk about oral nitroglycerin. These are tablets that you take once, twice, or three times a day, like isosorbide dinitrate, or ISDN. And then we talk about transdermal nitrate. These are patches that we apply somewhere on the body for 12 hours a time. The classic example is nitro patch. Nitrates are derived from nitroglycerin. And yes, it is the same stuff that's found in dynamite. In fact, there's a disease call "Monday syndrome", and I'll talk about it in a minute, which actually led us to discovery of the cardiac properties of nitroglycerin. Nitrates act as both venodilators and arteriodilators. As a venodilator, it reduces your cardiac output and it reduces your oxygen demand, or what we call preload as well. Arterial dilation opens up the myocardial vascular bed. It also reduces afterload on the heart. Now, there are many kinds of nitrates. They are de-nitrated in the liver. You have binitrates or dinitrates, like glyceryl dinitrate, which is a vasodilator. Or you can have mononitrates or just nitrates, like glyceryl mononitrate or isosorbide mononitrate. These agents release nitric oxide. Now, nitric oxide stimulates cyclic GMP and dephosphorylation of light chain myosin-phosphate complexes. So, what ends up happening is is that's how you have relaxation of the muscle unit, and therefore, either veno or arterial dilatation. Side effects of nitrates, almost everybody gets a headache. That's often thought of because we probably are dilating blood vessels in the brain, and causing a headache that way. Drug interactions. I've mentioned this before, especially in both the high blood pressure lecture, the hypertension lecture and the ANS lecture. Interactions between PDE5 inhibitors, like sildenafil which is...

    About the Lecture

    The lecture Nitrates – Angina and Heart Failure Management by Pravin Shukle, MD is from the course Cardiovascular Pharmacology.


    Included Quiz Questions

    1. interacts with nitrates. Sildenafil will increase levels of cGMP by inhibiting its breakdown, while nitrates increase levels of cGMP by increasing its production.
    2. interacts with nitrates. Sildenafil will increase levels of cGMP by increasing its breakdown, while nitrates increase levels of cGMP by inhibiting its production.
    3. interacts with nitrates. Sildenafil will increase levels of cGMP by increasing its production, while nitrates increase levels of cGMP by decreasing its breakdown.
    4. interacts with nitrates. Sildenafil will decrease levels of cGMP by decreasing its breakdown, while nitrates decrease levels of cGMP by decreasing its production.
    1. stimulates cyclic GMP and dephosphorylation of light chain myosin phosphate.
    2. stimulates cyclic GMP and phosphorylation of light chain myosin phosphate.
    1. amyl or sodium nitrate, which induces methemoglobin; or sodium thiosulfate, which combines with cyanide to create thiocyanate. These products are excreted more easily.
    2. amyl or sodium nitrate, which induces methemoglobin; or sodium thiosulfate which combines with cyanide to create thiocyanate. These products are stored in the fat cells as inert compounds.
    3. amyl or sodium nitrate, which induces thiocyanate; or sodium thiosulfate, which combines with cyanide to create methemoglobin. These products are excreted more easily.
    4. amyl nitrate, which induces methemoglobin, which binds to cyanide; or sodium nitrate, which combines with cyanide to create sodium thiosulfate. These products are excreted more easily.

    Author of lecture Nitrates – Angina and Heart Failure Management

     Pravin Shukle, MD

    Pravin Shukle, MD


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