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Nama Maba : Erwina Rusmawati

Nama Keluarga : Cardiology

LONG ACTING NITRATE

Nitrate or nitroglycerin is one of the oldest medications available for the

treatment of angina and heart disease. Nitrates are given to those patients who

have angina due to narrowed blood vessels most often caused by a build up of

fatty plaques known as atheromas, and work by helping the blood vessels in the

body relax, allowing for blood, oxygen and nutrients to flow more smoothly and

reach their target areas.1

Nitroglycerin dilates blood vessels reducing the workload of the heart and

improves blood flow to the heart. Nitroglycerin is used under the tongue to treat

attacks of angina. Long acting nitrates are given to those as a preventative

measure and aim to inhibit pain from occuring.2

All of the nitrates (GTN, isosorbide dinitrate, and isosorbide mononitrate)

come in long-acting preparations. A long-acting preparation takes longer to start

working, so is not much use for immediate pain relief. But, it works for much

longer after each dose than a short-acting preparation (which loses its effect after

20 minutes or so). Some preparations are slow-release or modified-release tablets.

When you swallow these they gradually release a steady amount of nitrate which

is absorbed into the body. Some preparations come as skin patches or ointments

which release a steady amount of nitrate into the bloodstream through the skin.3

These drugs are not useful for immediate pain relief as they take longer to

work but, as they slowly release a constant amount of the drug into the body, they

are better at preventing angina attacks from occuring.If a long acting nitrate is

prescribed, there is a chance that you may become tolerant to it and it will stop

being as effective. Due to this, the preparations and pattern of dosage are designed

to allow absorption to take a place over less than 24 hours leaving the body a few

hours its effects allowing the tolerance level to drop.2

As the mechanism of this groups of drugs causes the blood vessels to

dilate, the patient may experience a temporary flushing of the skin as the blood is

permitted through the vessels. This is more common in those taking long acting

nitrates. Along with this flushing, a headache can develop along with dizziness,

again these are not serious and will subside.4

If nitrate stays in your bloodstream all the time, your body becomes used

to it and the nitrate then has much less of an effect. To overcome this tolerance the

dose schedule aims to leave your blood free of nitrate, or with very low levels, for

a few hours each day. This is why the slow-release tablets may not be prescribed

at equal intervals throughout the day. This can result in your body being free of

nitrate in the early hours when you are asleep.5

The use of nitrates is contraindicated in the presence of certain medical

illness all of which should be discussed throughly with the doctor. They can also

interfere with some medications and should not be taken with any Viagra

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preparations or similar drugs. Overall nitrates are safe medications with no long

term or potentially serious side efffect.4

References

1. MH., Mellow. 2011. Nitrates.http://www.sciencedirect.com/science/article.html . Accessed on 11

thAugust

2011. At 20.15.

2. Johnson, J. 2010. Long Acting Nitrate-Cardiac Matters.http://www.cardiacmatters.co.uk/longactingnitrates.html. Accessed on 11

th

August 2011. At 20.15.

3. Smith, William. 2009. Guide For Heart Attack, Heart Surgery andCardiovascular Disease Patients. http://www.nhlbi.nih.gov/health/index.html.

Accessed on 12th

August 2011. At 07.30.

4. JW, Kikendall. 2010.Effect of sublingual nitroglycerin and long-acting nitratepreparations on esophageal motility

.

http://ukpmc.ac.uk/abstract/MED.html. Accessed on 11

thAugust 2011. At 20.30.

5. Yannios, Thomas. 2009. What Even Your Doctor Doesnt Know AboutPreventing a Heart Attack.http://www.medtronic.com/cardiac.html. Accessed

on 13th

August 2011. At 20.30.

http://www.sciencedirect.com/science/article.htmlhttp://www.sciencedirect.com/science/article.htmlhttp://www.cardiacmatters.co.uk/longactingnitrates.htmlhttp://www.nhlbi.nih.gov/health/index.htmlhttp://ukpmc.ac.uk/abstract/MED.htmlhttp://www.medtronic.com/cardiac.htmlhttp://www.medtronic.com/cardiac.htmlhttp://ukpmc.ac.uk/abstract/MED.htmlhttp://www.nhlbi.nih.gov/health/index.htmlhttp://www.cardiacmatters.co.uk/longactingnitrates.htmlhttp://www.sciencedirect.com/science/article.html