Nitrates

Question 1

Generic drug names
Nitrates

Answer 1

Glyceryl trinitrate
Isosorbide dinitrate
Isosorbide mononitrate

Question 2

Suffix
Nitrates

Answer 2

itrate

Question 3

“itrate” Drug class

Answer 3

Nitrates

Question 4

Indication
Nitrates

Answer 4

Angina

Question 5

MOA
Nitrates

Answer 5

Provide exogenous source of nitric oxide (which mediates vasodilator effects). Predominantly venodilators; reduce venous return and preload to the heart, reducing myocardial oxygen requirement.

Question 6

Precautions
Nitrates

Answer 6

Hypovolaemia—contraindicated.
Raised intracranial pressure—contraindicated.

Question 7

Adverse effects
Nitrates

Answer 7

Most are due to vasodilator effects:

headache, flushing, palpitations, orthostatic hypotension, fainting, peripheral oedema

Question 8

Counselling
Nitrates

Answer 8

This medicine may make you feel dizzy on standing. Get up gradually from sitting or lying to minimise this effect; sit or lie down if you become dizzy.

Question 9

Practice points
Nitrates

Answer 9

tolerance to nitrates (with loss of effect) occurs with continuous exposure; avoid by ensuring a nitrate-free interval from long-acting nitrates (see Glyceryl trinitrate, Isosorbide mononitrate); sublingual nitrates can be used if needed during the nitrate-free interval

Question 10

Drug class and indication

Glyceryl Trinitrate

Answer 10

Nitrates
Prevention and treatment of stable angina
Heart failure associated with acute MI (infusion)

Question 11

Drug class and indication

Isosorbide dinitrate

Answer 11

Nitrates
Prevention and treatment of angina

Question 12

Drug class and indication

Isosorbide mononitrate

Answer 12

Nitrates
Prevention of angina

Question 13

Drug interactions
Nitrates

Answer 13

Nitrates (including sodium nitroprusside), as well as amyl nitrite, cause hypotension and, if given with other drugs* that reduce BP, may have additional hypotensive effects.