PDF Nitrates and Nitrate Tolerance in Angina Pectoris

Free download. Book file PDF easily for everyone and every device. You can download and read online Nitrates and Nitrate Tolerance in Angina Pectoris file PDF Book only if you are registered here. And also you can download or read online all Book PDF file that related with Nitrates and Nitrate Tolerance in Angina Pectoris book. Happy reading Nitrates and Nitrate Tolerance in Angina Pectoris Bookeveryone. Download file Free Book PDF Nitrates and Nitrate Tolerance in Angina Pectoris at Complete PDF Library. This Book have some digital formats such us :paperbook, ebook, kindle, epub, fb2 and another formats. Here is The CompletePDF Book Library. It's free to register here to get Book file PDF Nitrates and Nitrate Tolerance in Angina Pectoris Pocket Guide.

Whether a specific drug is useful or harmful under heart failure and myocardial infarction depends on its speed of action: Fast acting substances such as glyceryl trinitrate and nitroprusside can be helpful for controlling blood pressure and consequently the amount of blood the heart has to pump, if the application is monitored continuously. Slow acting substances would hold the danger of ischaemia due to an uncontrollably low blood pressure and are therefore contraindicated.

Depending on the circumstances, even fast acting substances can be contraindicated — for example, glyceryl trinitrate in patients with obstructive heart failure. These drugs are also contraindicated in patients that have recently taken PDE5 inhibitors such as sildenafil Viagra. Most side effects are direct consequences of the vasodilation and the following low blood pressure. They include headache "nitrate headache" resulting from the widening of blood vessels in the brain, reflex tachycardia fast heart rate , flush , dizziness, nausea and vomiting.

Nicorandil Long-Acting Nitrates Vasodilator | ECR Journal

These effects usually subside after a few days if the treatment is continued. Occasionally, severe hypotension occurs shortly after beginning of treatment, possibly resulting in intensified angina symptoms or syncope , sometimes with bradycardia slow heart rate. A number of drugs add to the low blood pressure caused by nitrovasodilators: for example, other vasodilators, antihypertensive drugs , tricyclic antidepressantss , antipsychotics , general anaesthetics , as well as ethanol. Combination with PDE5 inhibitors, including sildenafil Viagra , is contraindicated because potentially life-threatening hypotension may occur.

Nitrates increase the bioavailability of dihydroergotamine DHE. High DHE levels may result in coronary spasms in patients with coronary disease. Nitrovasodilators are prodrugs that donate NO by various mechanisms. Nitrates undergo chemical reduction, likely mediated by enzymes. NO stimulates the soluble form of the enzyme guanylate cyclase in the smooth muscle cells of blood vessels.

Nitrate Therapy and Nitrate Tolerance

The most important effect in angina is the widening of veins , which increases their capacity to hold blood "venous pooling" and reduces the pressure of the blood returning to the heart the preload. Widening of the large arteries also reduces the pressure against which the heart has to pump, the afterload. Lower preload and afterload result in the heart needing less energy and thus less oxygen. Besides, NO donated by nitrovasodilators can reduce coronary spasms , increasing the heart's oxygen supply.

In combination with the increased cGMP production caused by nitrovasodilators, this leads to high concentrations of cGMP, extensive venous pooling, and potentially life-threatening hypotension. Nitrates exhibit development of tolerance, or more specifically tachyphylaxis , meaning that repeated application results in a fast decrease of effect, usually within 24 hours.

A pause of six to eight hours restores the original effectiveness. This phenomenon was originally thought to be a consequence of depletion of thiol —SH groups necessary for the reduction of nitrates. While this theory would fit the fact that molsidomine which is not reduced does not exhibit tachyphylaxis, it has meanwhile been refuted. Newer theories include increase of oxidative stress resulting in deactivation of NO to peroxynitrite , and liberation of the vasoconstrictors angiotensin II and endothelin as the blood vessels' reaction to NO-mediated vasodilation.

Nitrates mainly differ in speed and duration of their action. Nitrates vary in their potential to induce the development of tolerance. During long-lasting nitrate therapy, except pentaerythritol tetranitrate PETN , one can observe the development of reactive oxygen species ROS inside the muscular cell of a vessel wall, and these bind with nitric oxide NO. This leads to decreased NO activity, thus, nitrate tolerance.

Keywords: Stable angina pectoris, organic nitrates, nitrate tolerance, nitrate cross-tolerance. Affiliation: 2nd Dept.


Abstract: Long-acting nitrates are effective antianginal drugs during initial treatment. Journal Name: Current Clinical Pharmacology. Volume 4 , Issue 2 , Barbara McGovern. The Lancet: Cardiovascular Disease The Lancet. Acute Pulmonary Embolism. Vascular Tumors and Developmental Malformations.

Do you have an account?

Paula E. Michael Crawford. Clinical Autonomic Dysfunction. Joseph Colombo. Neonatal Cardiology, Second Edition. Michael Artman. Radiation Therapy for Gastrointestinal Cancers. Theodore Hong. Electrophysiologic Testing. Richard N. Fogoros MD. The ACL Handbook. Martha M.

Navigation menu

Michael A. Viola Hach-Wunderle. Magnetic Resonance Angiography. James C. Caring for the Heart. W Bruce Fye. Tarik El Sheikh. Immunohistochemistry in Tumor Diagnostics. Muin S.

  1. Confiance en soi (French Edition);
  2. Embroidery Machine Basics - With over 100 Machine Embroidery Tips & Hints for the Complete Beginner.
  3. More titles to consider.

Management and Leadership Skills for Medical Faculty. Anthony J.

Join Kobo & start eReading today

The ECG. The Cardiac Lymphatic System. Ganga Karunamuni. Mineralocorticoids and Hypertension. Thoracic Outlet Syndrome. Julie Ann Freischlag. Min Yao. Advances in Noninvasive Electrocardiographic Monitoring Techniques. Vinzenz Hombach. Immunology and Its Impact on Infections in Surgery.

Rainer Engemann.

  • Un cappuccino con molto zucchero (Italian Edition)!
  • School of Velocity for Beginners, Opus 141: For Piano: 0 (Kalmus Edition).
  • The role of organic nitrates in the optimal medical management of angina.
  • Vingt mille lieues sous les mers (édition adaptée) (FLAMMARION JEUN) (French Edition)!
  • Gerhart Hauptmann: Bürgerlichkeit und großer Traum (German Edition).
  • Textbook of Rapid Response Systems. Daryl A. Principles and Practice of Urooncology. Gokhan Ozyigit. Marc A. Complications of Interventional Cardiovascular Procedures. Steven R. Radiation Oncology of Gynecological Cancers. Endocrine Regulation of Electrolyte Balance. George D. Principles of Pulmonary Protection in Heart Surgery. Edmo Atique Gabriel.