Short-acting nitrate preparations
- Glyceryl trinitrate (GTN) tablets or sprays are commonly used to ease angina pains.
- Isosorbide dinitrate is sometimes used as an alternative to GTN for the immediate relief of angina pains when they develop. Again, it comes in tablet and spray form.
What is the difference between short acting and long acting nitrates?
Short-acting nitrates (SL or sublingual) should be carried by anyone who is being treated for angina. The long-acting nitrates (pills or skin patches) are considered a second-line form of therapy for angina. They are prescribed if beta blockers (first-line therapy) cannot be tolerated, or are ineffective in eliminating symptoms.
What are nitrates used for?
Nitrates have been a mainstay in the treatment of angina for over 100 years. Today, nitrates are used both to treat acute episodes of angina (in the form of sublingual nitroglycerin or nitroglycerin oral spray), and chronically (in pill form or as a skin patch) to help prevent angina. 1 How Do Nitrates Work?
What nitrates are used to prevent angina pectoris?
Some nitrates are used to prevent angina pectoris due to heart disease (coronary artery disease). These include short-acting and long-acting nitrates in the form of oral tablets and capsules, as well as transdermal (patches), and topical ointment products that contain nitroglycerin.
What are the different types of nitrates?
The main types of nitrates are as followed[4]: Nitroglycerin (NTG) – angina pectoris (treatment/prophylaxis), acute coronary syndrome, heart failure, hypertension Isosorbide mononitrate (ISMN) – chronic angina pectoris (treatment) Isosorbide dinitrate (ISDN) – angina pectoris (treatment/prophylaxis)
What are three types of nitrates?
The main types of nitrates are as followed[4]: Nitroglycerin (NTG) – angina pectoris (treatment/prophylaxis), acute coronary syndrome, heart failure, hypertension. Isosorbide mononitrate (ISMN) – chronic angina pectoris (treatment) Isosorbide dinitrate (ISDN) – angina pectoris (treatment/prophylaxis)
What are examples of nitrates?
Some nitrates include: Dilatrate-SR, Iso-Bid, Isonate, Isorbid, Isordil, Isotrate, Sorbitrate (isosorbide dinitrate) Imdur (isosorbide mononitrate) BiDil (hydralazine with isosorbide dinitrate)
What are long acting nitrates?
Long-acting nitrates help to reduce chest pain (angina). They widen your blood vessels to increase blood flow to the heart. Long acting-nitrates are in tablet form and are different to GTN spray.
Is nitroglycerin a short-acting nitrate?
Nitroglycerin was first formulated as a short-acting nitrate preparation for clinical use in 1879, and is the oldest and most commonly prescribed short-acting anti-anginal agent.
What meds are considered nitrates?
Medicines that contain organic nitrates include:Nitroglycerin (such as Nitro-Dur, Nitrolingual, Nitrostat).Isosorbide (such as Dilatrate, Isordil).Nitroprusside (such as Nitropress).Amyl nitrite or amyl nitrate. These are sometimes called "poppers." They are sometimes abused.
What nitrates to avoid with Viagra?
Commonly used nitrates that can interact with Viagra include nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, erythrityl tetranitrate, pentaerythritol tetranitrate, sodium nitroprusside and amyl nitrate.
What is the difference between isosorbide mononitrate and dinitrate?
Isosorbide mononitrate comes as standard tablets and slow-release (modified release) tablets and capsules. Isosorbide dinitrate comes as standard tablets and slow-release tablets. Slow-release tablets and capsules release the medicine gradually into your body.
Is Nitro paste a long-acting nitrate?
Nitroglycerin eases chest pain (angina) by getting more blood and oxygen to your heart. It also works by reducing the heart's need for oxygen by dilating the arteries. Long-acting nitroglycerin helps prevent angina from starting.
Can you take nitrates with Viagra?
But medical groups such as the American Heart Association advise men to avoid taking nitrates within at least 24 hours of shorter-acting erectile dysfunction drugs, including Viagra (sildenafil) and Levitra (vardenafil), and within at least 48 hours of a longer-acting drug, such as Cialis (tadalafil).
Is isosorbide dinitrate a long acting nitrate?
Long-acting nitrate preparations All the nitrates (GTN, isosorbide dinitrate, and isosorbide mononitrate) come in long-acting preparations.
Is isosorbide a long acting nitrate?
Isosorbide comes as a tablet, an extended-release (long-acting) tablet, and an extended-release capsule to take by mouth. The tablet usually is taken two or three times daily.
What is the difference between nitroglycerin and nitroprusside?
Nitroprusside is a potent arterial and venous vasodilator. It produces more balanced arterial and venous dilation compared to nitroglycerin (which is more of a venodilator particularly at low doses).
What foods have high nitrates?
The foods highest in nitrate include beet roots and leafy greens such kale, arugula, chard, and spinach. Others include parsley, Chinese cabbage, leeks, celery, radishes, and turnips.
What foods contain nitrites?
Approximately 80% of dietary nitrates are derived from vegetable consumption; sources of nitrites include vegetables, fruit, and processed meats. Nitrites are produced endogenously through the oxidation of nitric oxide and through a reduction of nitrate by commensal bacteria in the mouth and gastrointestinal tract.
What foods have added nitrates?
Foods With Added NitratesHam. Ham is often the highest source of dietary nitrates. ... Bacon. Bacon has up to 380 mcg of nitrates per 100 g of weight. ... Deli Meat. Deli meat is another major source of harmful nitrates. ... Hot Dogs. Hot dogs are one of the most processed sources of meat on the market.
What are nitrates?
Nitrates and nitrites are compounds that occur naturally in the human body and some foods. They're also added to certain processed foods to extend shelf life. They can change into nitric oxide, dilate your blood vessels, and lower blood pressure. Moreover, they may enhance physical performance.
What is nitroglycerin used for?
Intravenous nitroglycerin is useful for hypertensive emergencies . [2][3]
What is the effect of nitrates on the heart?
Nitrates are a class of medications (not to be confused with the byproduct of nitrogen fertilizers) that cause vasodilation by donating nitric oxide (NO).[1] Nitrates exert their effects by dilating venous vessels, coronary arteries, and small arterioles ; its maximal vasodilation is in the venous vessels. [2]
Why are nitrates used in angina?
Nitrates are useful in the management and treatment of angina. They are a group of medications that cause vasodilation by donating nitric oxide. This activity reviews the indications, action, and contraindications for nitrates as a valuable agent in the management of angina and other cardiovascular diseases.
What diseases are nitrates used for?
The use of nitrates is indicated in the following cardiovascular diseases : angina pectoris, acute coronary syndrome, arterial hypertension, and heart failure. [1][2]
How do nitrates affect the body?
Nitrates exert their pharmacological effect by being activated by mitochondrial or cytosolic aldehyde dehydrogenase (ALDH2) into nitric oxide (NO), an endothelium-derived relaxing factor (EDRF).[2] NO is generally produced by the endothelium to dilate the blood vessels; however, endothelial dysfunction in diseases such as atherosclerosis can deplete NO levels.[2] When administered, nitrates convert to NO, which then activates soluble guanylate cyclase.[2] This action results in increased levels of intracellular cyclic guanosine monophosphate (cGMP) and its dependent protein kinases, such as cGMP-dependent protein kinase I (cGK-I). cGK-I inhibits inositol-1,4,5-trisphosphate-dependent calcium release. The decreased intracellular calcium levels subsequently inhibit myosin light chain kinase, and the unphosphorylated myosin light chain causes myosin head to detach from actin, resulting in smooth muscle relaxation.[5] The NO-cGMP-cGK-I signaling pathway causes vasorelaxation, platelet disaggregation, and prevention of platelet adhesion. [2][6]
What is nitrates used for?
Nitrates are the first-line medication for angina, one of the main symptoms of coronary heart disease. Multiple health care professionals such as general practitioners (GP), home care workers, pharmacists, and dieticians can work together to improve patients’ quality of life and prevent exacerbation of the disease.[10] Communication between the providers can prevent adverse drug interactions when prescribing nitrates, and limit side effects in patients who are at increased risk. Since chronic heart failure and erectile dysfunction frequently occur concomitantly,[11]pharmacists, nurses, and GPs should ensure nitrates therapy is not an option if the patient is on PDE inhibitors. Home care professional nurses should also work with GPs for elderly patients who are prone to hypotension to prevent syncope. [Level III]
When were nitrates first used?
Nitrates were first discovered in 1847 as a treatment for chest pain. [1][2]The type of nitrates used and the administration route differs depending on the type of cardiovascular disease. The purpose of nitrate use is multifaceted. For patients with stable and predictable angina, long-acting nitrate can be used as prophylaxis, increasing exercise tolerance in patients.[3] This effect can be beneficial since patients with coronary artery disease tend to have other co-morbidities. For patients with acute anginal pain, short-acting nitrates are useful for symptom relief. [3]
What is nitroglycerin used for?from ncbi.nlm.nih.gov
Intravenous nitroglycerin is useful for hypertensive emergencies . [2][3]
What is the effect of nitrates on the heart?from ncbi.nlm.nih.gov
Nitrates are a class of medications (not to be confused with the byproduct of nitrogen fertilizers) that cause vasodilation by donating nitric oxide (NO).[1] Nitrates exert their effects by dilating venous vessels, coronary arteries, and small arterioles ; its maximal vasodilation is in the venous vessels. [2]
Why are nitrates used in angina?from ncbi.nlm.nih.gov
Nitrates are useful in the management and treatment of angina. They are a group of medications that cause vasodilation by donating nitric oxide. This activity reviews the indications, action, and contraindications for nitrates as a valuable agent in the management of angina and other cardiovascular diseases.
What diseases are nitrates used for?from ncbi.nlm.nih.gov
The use of nitrates is indicated in the following cardiovascular diseases : angina pectoris, acute coronary syndrome, arterial hypertension, and heart failure. [1][2]
Why are nitrates considered a third line therapy?from pubmed.ncbi.nlm.nih.gov
In stable angina long-acting nitrates are considered third-line therapy because a nitrate-free interval is required to avoid the development of tolerance. Nitrates vary in their potential to induce the development of tolerance.
How do nitrates affect the body?from ncbi.nlm.nih.gov
Nitrates exert their pharmacological effect by being activated by mitochondrial or cytosolic aldehyde dehydrogenase (ALDH2) into nitric oxide (NO), an endothelium-derived relaxing factor (EDRF).[2] NO is generally produced by the endothelium to dilate the blood vessels; however, endothelial dysfunction in diseases such as atherosclerosis can deplete NO levels.[2] When administered, nitrates convert to NO, which then activates soluble guanylate cyclase.[2] This action results in increased levels of intracellular cyclic guanosine monophosphate (cGMP) and its dependent protein kinases, such as cGMP-dependent protein kinase I (cGK-I). cGK-I inhibits inositol-1,4,5-trisphosphate-dependent calcium release. The decreased intracellular calcium levels subsequently inhibit myosin light chain kinase, and the unphosphorylated myosin light chain causes myosin head to detach from actin, resulting in smooth muscle relaxation.[5] The NO-cGMP-cGK-I signaling pathway causes vasorelaxation, platelet disaggregation, and prevention of platelet adhesion. [2][6]
What is nitrates used for?from ncbi.nlm.nih.gov
Nitrates are the first-line medication for angina, one of the main symptoms of coronary heart disease. Multiple health care professionals such as general practitioners (GP), home care workers, pharmacists, and dieticians can work together to improve patients’ quality of life and prevent exacerbation of the disease.[10] Communication between the providers can prevent adverse drug interactions when prescribing nitrates, and limit side effects in patients who are at increased risk. Since chronic heart failure and erectile dysfunction frequently occur concomitantly,[11]pharmacists, nurses, and GPs should ensure nitrates therapy is not an option if the patient is on PDE inhibitors. Home care professional nurses should also work with GPs for elderly patients who are prone to hypotension to prevent syncope. [Level III]
Why are nitrates considered a third line therapy?
In stable angina long-acting nitrates are considered third-line therapy because a nitrate-free interval is required to avoid the development of tolerance. Nitrates vary in their potential to induce the development of tolerance.
Is nitrate a long acting drug?
Long-acting nitrates are effective antianginal drugs during initial treatment. However, their therapeutic value is compromised by the rapid development of tolerance during sustained therapy, which means that their clinical efficacy is decreased during long-term use. Sublingual nitroglycerin (NTG), a …
How Do Nitrates Work?
Nitrates work by dilating arteries and veins, both in the heart and elsewhere in the body. This general dilation of blood vessels reduces stress on the heart muscle, and thus reduces the amount of oxygen the heart requires. Reducing heart’s oxygen requirements allows the heart to do more work without developing ischemia, even if blood flow through the coronary arteries is partially blocked by atherosclerosis. 1
What is the problem with long acting nitrates?
The biggest problem with the use of long-acting nitrates has been the phenomenon of "tolerance.". Nitrate tolerance means that the benefits of nitrate therapy can become reduced when nitrates are used around the clock. Simply speaking, when the blood vessels are always exposed to nitrates, they stop dilating in response to the nitrates, ...
What is nitrate used for?
Today, nitrates are used both to treat acute episodes of angina (in the form of sublingual nitroglycerin or nitroglycerin oral spray), and chronically (in pill form or as a skin patch) to help prevent angina. Johner Images / Getty Images.
What is SL nitroglycerin?
Sublingual (SL) nitroglycerin (nitroglycerin that is rapidly absorbed from under the tongue) is the oldest form of nitrate therapy. SL nitroglycerin is the quickest way to relieve an episode of angina brought on by exercise or stress and commonly provides relief within minutes.
How long does SL nitroglycerin last?
SL nitroglycerin begins dilating blood vessels within two minutes, and its effect can last up to 30 minutes. Nitroglycerin spray, delivered into the mouth by a metered-dose device, works similarly to SL nitroglycerin — it is simply another method of delivering a rapid-acting dose of nitroglycerin.
How long does nitrates last?
With oral nitrates, the effect on blood vessels begins within approximately 30 minutes and lasts for up to six hours.
When to use nitrates for nocturnal angina?
In some patients with nocturnal angina, however, the nitrate-free interval may need to be scheduled during waking hours.
What is the mechanism of action of nitrates?
Mechanism of action of nitrates: Nitrates get metabolised to form nitric oxide, which is a potent vasodilator. Nitric oxide is also the endothelium derived relaxing factor. Nitric oxide stimulates the enzyme guanylate cyclase, which causes the synthesis of cyclic guanosine monophosphate (cGMP).
What is cyclic GMP?
Cyclic GMP is a second messenger which activates protein kinase. Protein kinases cause de-phosphorylation of myosin light chains in the smooth muscle cells. The contractile state of the smooth muscles is due to phosphorylation of the myosin light chains. Hence de-phosphorylation of these lead to relaxation of smooth muscle.
What is the predominant action of venodilatation?
The predominant action is on veins, causes venodilatation and decreased venous return to the heart. This lowers the myocardial preload and hence the myocardial oxygen demand. There is also an arterial dilatory effect, which reduces the after load. This effect occurs at a higher dose than that which produces venodilatation.
