Nicorandil

Question 1

What is nicorandil?

Answer 1

• Nicorandil is a vasodilatory drug used to treat angina
• It is a potassium-channel activator :. activation of guanylyl cyclase :. increase cGMP

Question 2

What are the side effects of nicorandil?

Answer 2

1. Headache
2. Flushing
3. Anal ulceration

Question 3

What are the contraindications of nicorandil?

Answer 3

Left ventricular failure

Question 4

What is nicotinic acid?

Answer 4

• Nicotinic acid (niacin) is used in the treatment of patients with hyperlipidaemia
• Lowers cholesterol and triglyceride concentrations
• Raises HDL levels

Question 5

What are the side effects of nicotinic acid?

Answer 5

1. Flushing: mediated by prostaglandins
2. Impaired glucose tolerance
3. Myositis

Question 6

What are nitrates?

Answer 6

• Nitrates are a group of drugs which have vasodilating effects
• Main indications: angina and the acute treatment of heart failure
• Sublingual glyceryl trinitrate most commonly used in ischaemic heart disease to relieve angina attacks

Question 7

What is the MOA of nitrates?

Answer 7

1. Nitrates cause the release of nitric oxide in smooth muscle :. activating guanylate cyclase which then converts GTP to cGMP :. fall in intracellular calcium levels
2. In angina:
   
   • dilate the coronary arteries
   • reduce venous return :. reduces left ventricular work :. reducing myocardial oxygen demand

Question 8

What are the side effects of nitrates?

Answer 8

• Hypotension
• Tachycardia
• Headaches
• Flushing

Question 9

What is nitrate tolerance?

Answer 9

• Many patients who take nitrates develop tolerance and experience reduced efficacy
• Patients who develop tolerance:
  
  • take the second dose of isosorbide mononitrate after 8 hours (rather than after 12 hours)
  • This allows blood-nitrate levels to fall for 4 hours and maintains effectiveness
• This effect not seen in patients who take modified release isosorbide mononitrate

Question 10

Who gets orthostatic hypotension?

Answer 10

• Orthostatic hypotension more common in older people
• Patients who have neurodegenerative disease (e.g. Parkinson’s) diabetes, or hypertension

Question 11

What are iatrogenic causes of alpha-blockers?

Answer 11

Alpha-blockers (e.g. for benign prostatic hyperplasia).

Question 12

What are the features of orthostatic hypotension?

Answer 12

• A drop in BP (usually >20/10 mm Hg) within three minutes of standing
• Presyncope
• Syncope

Question 13

What is the treatment of orthostatic hypotension?

Answer 13

1. Midodrine
2. Fludrocortisone