Week 7: Nitrates and Peripheral Vasodilators

Question 1

Nitrates MOA

Answer 1

direct vasodilator - relaxes smooth muscle by the intracellular conversion of nitrate ions to nitric oxide (increases cGMP) ==> smooth muscle relaxation - work on all vascular systems - decrease both preload and afterload

Question 2

2 types of nitrates

Answer 2

Quick acting - Nitro stat SL

Long acting

• Isosorbide mononitate
• Isosorbide dinitrate
• Imdur - Transdermal patch

Question 3

Nitrates ADRs

Answer 3

• headache, dizziness
• ortho hypotension
• rebound tachycardia

Question 4

Nitrates Drug interactions

Answer 4

• do not use concurrently with erectile dysfunction drugs (viagra, cialis, levitra)
• monitor for additive hypotension with antihypertensive medications, alcohol, beta blockers, calcium channel blockers

Question 5

Nitrates Patient Education

Answer 5

• take the drug exactly as prescribed
• must have a nitrate free window - at least 8 hours between doses and at least 10 to 12 hours between the last dose one day and the first dose the next day
• storage: keep the medication in a glass opaque bottle and protect from light and heat; can burn/tingle a little
• date when opened and check expiration date
• don’t abruptly stop long acting = withdrawal

Question 6

Vasodilators (hydralazine) MOA

Answer 6

• direct relaxation and dilation of arteriolar smooth muscle leading to a decrease in peripheral vascular resistance - decreases the workload of the heart

Question 7

Hydralazine/vasodilators cautions/ contraindications

Answer 7

• avoid in pts w/ CAD

- caution in mitral valvular disease, renal impairment

Question 8

Hydralazine/ vasodilators ADRs

Answer 8

• ortho hypotension
• headache
• rebound tachycardia
• palpitations
• edema/sodium and water retention (dilated vessels are leaky vessels)