1.Anti- Anginal Drugs: Nitrates (Part-1): CVS Pharmacology

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1.Anti - Anginal Drugs: Nitrates (Part-1): CVS Pharmacology
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Nitrates are potent anti-anginal drugs used to relieve and prevent angina pectoris by dilating blood vessels, improving oxygen delivery to the heart, and reducing myocardial oxygen demand ????????.

These drugs, including nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate, act by releasing nitric oxide (NO), which stimulates guanylate cyclase, increasing cyclic GMP (cGMP) levels and leading to smooth muscle relaxation ????????. Venodilation reduces preload, decreasing myocardial wall tension and oxygen consumption, while arterial dilation lowers afterload, further decreasing cardiac workload ????????.

Nitrates are first-line drugs in stable angina, providing rapid relief by increasing coronary perfusion and redistributing blood to ischemic heart areas ????????. They are available in sublingual, oral, transdermal, and intravenous forms, with sublingual nitroglycerin being the drug of choice for acute anginal attacks due to its rapid onset of action ⏳????.
However, nitrate tolerance can develop with prolonged use, requiring nitrate-free intervals to maintain effectiveness ????⚠️.

Common side effects include headache, hypotension, dizziness, reflex tachycardia, and flushing, making careful dose titration essential to prevent adverse reactions ????????. Contraindications include severe hypotension, hypertrophic cardiomyopathy, and concurrent PDE-5 inhibitors (e.g., sildenafil), as their combination can cause life-threatening hypotension ⚠️????. Nitrates remain a cornerstone in angina management, improving patient outcomes and enhancing quality of life when used appropriately ????????.

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