Heart Failure / ACS drugs

Question 1

Name an example of a short acting nitrate

When would it be used?

Answer 1

Glycaryl trinitrate

acute angina and chest pain in ACS

Question 2

Name an example of a long-acting nitrate

Answer 2

isosorbide mononitrate

either
1. prophylaxis of angina if beta blocker/ CCB ineffective

Question 3

What is the MOA of nitrates?

Answer 3

Get converted into NO and cause reduced intracellular Ca+ in vascular smooth mucle –> muscle relaxation

1. Venous vasodilatation and lesser extent arterial
2. Therefore reduction in cardiac work and myocardial oxygen demand –> relieve of angional and heart failure
3. (some effect also by dilation of coronary arteries but mainly through reduction of preload)

Question 4

What are the contraindications to nitrate use?

Answer 4

1. severe aortic stenosis
2. hypotension

(+ inportant interaction: cannot be perscribed with phosphodiesterase inhibitors (e.g. sildenafil) tdue to hypotension