12. Vasodilators: Nitric Oxide Releasers: Anti- Hypertensive Drugs: CVS Pharmacology

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12. Vasodilators: Nitric Oxide Releasers: Anti- Hypertensive Drugs: CVS Pharmacology
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Nitric oxide (NO) releasers are a crucial class of vasodilators that work by stimulating nitric oxide (NO) production, leading to vascular smooth muscle relaxation ????️, reduced blood pressure (BP) ????, and improved oxygen delivery ????. These drugs are primarily used for hypertension (HTN) ????, angina ????, heart failure ????, and hypertensive emergencies ????, as they effectively reduce both preload and afterload on the heart.

???? Mechanism of Action ????

NO activates guanylate cyclase (GC) ????️, increasing cyclic GMP (cGMP) ????, which promotes smooth muscle relaxation.
This results in vasodilation ????️, reduced peripheral resistance, and improved blood flow ????.
NO also inhibits platelet aggregation ????, making these drugs beneficial in coronary artery disease (CAD) ❤️.
???? Key Nitric Oxide Releasing Vasodilators ????

Nitroglycerin (GTN) ???? – Used in angina ????, heart failure ????, and hypertensive emergencies ????.
Isosorbide Dinitrate & Isosorbide Mononitrate ???? – Used in chronic stable angina & CHF.
Sodium Nitroprusside (SNP) ???? – A potent arterial & venous vasodilator, used in hypertensive crises ???? and acute heart failure.
Hydralazine ????️ – Works via NO release, primarily reducing afterload, used in hypertension & heart failure (especially in combination with isosorbide dinitrate in Black patients).
???? Clinical Uses ????

Hypertension (HTN) ???? & Hypertensive Emergencies ???? – Rapid BP reduction.
Angina ???? & Myocardial Infarction (MI) ❤️ – Improves coronary blood flow.
Heart Failure (CHF) ???? – Reduces cardiac workload & improves oxygen delivery.
Pulmonary Hypertension ???? – NO therapy enhances pulmonary vasodilation.
???? Side Effects ⚠️

Reflex tachycardia ????, headache ????, and flushing ????.
Nitrate tolerance ???? – Continuous exposure (e.g., GTN patches) reduces drug efficacy, requiring nitrate-free intervals.
Cyanide toxicity ☠️ (specific to sodium nitroprusside) in prolonged use.
Severe hypotension ????, necessitating careful monitoring.
NO-releasing vasodilators remain essential in cardiovascular medicine, providing rapid and effective BP control and reducing myocardial oxygen demand ????✨.

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