Nitrates in afya

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causes vasodilation
main indications - angina and acute treatment of heart failure. 
Sublingual glyceryl trinitrate - most common drug for anginal attacks in IHD

''Mechanism of action''
    cause release of nitric oxide in smooth muscle, increasing cGMP which leads to a fall in intracellular calcium levels
    in angina they both dilate the coronary arteries and also reduce venous return which in turn reduces left ventricular work, reducing myocardial oxygen demand

''Side-effects''
    hypotension
    tachycardia
    headaches
    flushing

''Nitrate tolerance''
    many patients who take nitrates develop tolerance and experience reduced efficacy
    the BNF advises that patients who develop tolerance should take the second dose of isosorbide mononitrate after 8 hours, rather than after 12 hours. This allows blood-nitrate levels to fall for 4 hours and maintains effectiveness
    this effect is not seen in patients who take modified release isosorbide mononitrate

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