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

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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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