Other cardiac

Question 1

MoA nitrates

Answer 1

nitrates cause the release of nitric oxide in smooth muscle, activating guanylate cyclase which then converts GTP to cGMP, which in turn leads to a fall in intracellular calcium levels

in angina they both dilate the coronary arteries and also reduce venous return which in turn reduces left ventricular work, reducing myocardial oxygen demand

Question 2

adverse effects nitrates

Answer 2

hypotension
tachycardia
headaches
flushing

Question 3

name a long acting nitrate

Answer 3

isosorbide mononitrate

Question 4

complication long term nitrates

Answer 4

tolerance and reduced efficacy

NICE advises that patients who take standard-release isosorbide mononitrate should use an asymmetric dosing interval to maintain a daily nitrate-free time of 10-14 hours to minimise the development of nitrate tolerance
this effect is not seen in patients who take once-daily modified-release isosorbide mononitrate

Question 5

contraindications and cautions GTN

Answer 5

hypothyroidism, recent MI, heart failire

acoid in hypotension/hypovolemia, aortic and mitral stenosis and cerebrovasucalr disease

Question 6

interactions GTN

Answer 6

antihypertensives

avoid sildenefil, tadalafil, vatdenafil