Antianginal drugs Flashcards
Organic Nitrates: MOA
Once in cells, molecules releases NO through enzymatic action. NO increases intracellular cGMP which leads to dephosphorylation of myosin light chain smooth muscle _______.
relaxation
how do organic nitrates work?
These drugs work by reducing the work of the heart through systemic vasodilation
(Drops total peripheral resistance in systemic circulation and puts less work on heart to pump against higher pressure)
Is nitro’s primary action through coronary dilation? why?
NO.
The primary action is NOT coronary artery dilation.diseased arteries do not dilate well)
Nitroglycerin different routes of administration
o IV
o Ointment (Nitro-BID)
o Spray (Nitrolingual, NitroMist)
o Sublingual tablets (Nitrostat, NitroQuick)
o Transdermal (Nitro-Dur, Minitran, Transderm-Nitro)
PO Formulations
o Isosorbide mononitrate (Imdur, ISMO)
o Isosorbide dinitrate (Isordil, Dilatrate-SR)
What formulations of nitro are considered short acting?
IV, OINTMENT, SPRAY, AND SUBLINGUAL IS SHORT ACTING- USED FOR ACUTE CHEST PAIN
What formulations of nitro are considered long acting?
PO Formulations, Transdermal is long acting.
ointment- old use was long acting
Are the short acting or long acting nitro drugs used for prophylaxis?
long acting
uses for IV nitro
acute angina, acute MI, perioperative/emergency HTN
uses for sublingual nitro
acute angina treatment
(sometimes also prophylaxis- VERY SPECIFIC SITUATIONS- if someone knows they are about to do something that will cause chest pain they can take this, like push mowing lawn, etc.)
uses for transdermal nitro
prophylaxis
uses for ointment nitro
prophylaxis
Organic Nitrates: ADR
3
Headache
Facial flushing
Hypotension
why does nitro induce migraines?
It dilates blood vessels in head and you get throbbing headache
What is the main DDI you need to be concerned about with NITRO?
Main DDI is with PDE-5 Inhibitors- erectile dysfunction drugs.
Avoid concurrent use with PDE-5 inhibitors (e.g., sildenafil, tadalafil, vardenafil)
When nitrate administration becomes medically necessary, you may administer nitrates only if ___hours have elapsed after use of sildenafil or vardenafil (48 hours after tadalafil use)
24
If you use nitro with someone who has taken PDE-5 inhibitors in last 24 hours, what can happen?
they can have a dangerous drop in BP.
when can organic nitrate tolerance develop?
Can develop if dosed continuously or too often
You MUST provide________ on nitrate-free intervals (typically at least 12 hours)
pt education
- Use of various products requires specific education
When using sublingual nitrate, why can’t the patient just swallow it?
• It won’t work because it gets rapidly inactivated in stomach and won’t be able to get into system and cause vasodilation.
What are the two forms of sublingual nitro?
SL tablets/spray
are SL nitro tablets or spray more effective?
Both just as effective
When should you call 911 after use of nitro?
Call 911 if no pain relief after 5 min
how often can you give sublingual nitro for acute angina?
Can repeat q5 min
Typically max 3 doses
nitro tablets are sensitive to what?
light/heat sensitive
