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Flashcards in Nitrates Deck (15)
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1
Q

Give 3 examples of nitrates?

A
  • Glyceryl trinitrate (GTN)
  • Isosorbide mononitrate (ISMN)
  • Isosorbide dinitrate (ISDN)
2
Q

What is the mechanism of action of GTN?

A

It is converted to nitric oxide (NO), which causes blood vessels to relax and dilate, so there is a reduction in vascular resistance and more blood is delivered to the body, relieving angina

3
Q

What are the routes of delivery of GTN?

A
  • Sublingual (tablet or spray)
  • Continuous IV infusion
  • Transdermal patch
  • Ointment (rarely)
4
Q

What is the indication for GTN spray?

A

Treatment of angina

5
Q

What is the indication for ISMN and ISDN?

A

Prophylaxis of angina

6
Q

What is the contraindication to nitrates?

A

Severe aortic stenosis

7
Q

Why are nitrates contraindicated in severe aortic stenosis?

A

Vasodilation by nitrate can cause significant drop in blood pressure, which is dangerous in fixed cardiac output states

8
Q

What might nitrates interact with?

A

Phosphodiesterase inhibitors, e.g. sildanafil

9
Q

What monitoring should be done with nitrates?

A

BP monitoring when GTN given as IV infusion

10
Q

What should be done if BP drops below 90 with GTN infusion?

A

Stop, unless advised otherwise

11
Q

What are the common side effects of nitrates?

A
  • Flushing
  • Tachycardia
  • Throbbing headaches
  • Dizziness
  • Postural hypotension
12
Q

What are the less common side effects of nitrates?

A
  • Nausea
  • Syncope
  • Tolerance (after prolonged use)
13
Q

What counselling is required with nitrates?

A
  • Demonstrate GTN spray use
  • What to do if chest pain occurs
  • Side effects
  • Tolerance
14
Q

What should patients who take GTN tablets be aware of?

A

Tablets only last for 8 weeks after opening the bottle

15
Q

What should patients be advised to do if chest pain occurs?

A

Take GTN spray and ring for ambulance immediately