Nitrates

Nitrates:
• eg nitroglycerin, erythrityl tetranitrate, glyceryltrinitrate (GIN), amyl nitrite
• fast acting
• indications – acute treatment and prophylaxis of angina pectoris  decreases pain associated with exertion by decreasing oxygen demand
• most decompose to nitric oxide  activates guanylylcyclase  increased levels of cAMP  activation of protein kinase G and phosphorylation of contractile proteins  dilation of systemic veins  decreased preload  decreases oxygen demands on heart (only modest vasodilatory effect on arterioles)
• nitroglycerin comes in several forms – IV, sublingual tablet (highly lipid soluble  crosses membranes easily), sustained release capsule, transdermal ointment and patch, translingual spray
• adverse effects – headaches (can be severe); hypotension (severe if taken with alcohol); reflex tachycardia