USMLE (Fach) / Pharmacology - Cardiovascular (Lektion)
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Nitrates
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Nitroglycerin, isosorbide dinitrate, isosorbide mononitrate.- Nitroglycerin: sublingual, transdermal, IV- Isosorbide: oral, extended release for chronic use
Vasodilate by ↑ NO in vascular smooth muscle → ↑ cGMP and smooth muscle relaxation. - Dilate veins >> arteries. - ↓ preload
Clinical use: Angina, acute coronary syndrome, pulmonary edema.
Adverse effects:- Flushing, headache, orthostatic hypotension- "Monday disease" in industrial exposure: tolerance for the vasodilating action during the work week and loss of tolerance over the weekend → tachycardia, dizziness, headache- Reflex tachycardia (treat with β-blockers) - Contraindicated in right ventricular infarction.
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