Glyceryl trinitrate angina

On the other hand, insufficient NO production also causes serious medical problems. Many diseases such as hypertension, atherosclerosis and restenosis involve a deficiency of NO production. Therefore, a compound that can release NO under specific conditions can be used therapeutically to palliate NO underproduction. In fact, the best known NO donor, glyceryl trinitrate, has been used for over a century to relieve acute attacks of angina pectoris. 

A number of organic nitrates are potent vasodilators and have been used clinically for over lOOyears, particularly for the relief of the symptoms of angina (Fig. 8.6). The most widely used is glyceryl trinitrate (GTN) but the group includes pentaerythrityl tetranitrate (PETN), isosorbide mononitrate (ISMO) andisosorbide dinitrate (ISDN). 

Over a century ago, empirical observation was made that organic nitrates, including glyceryl trinitrate (GTN), alleviate angina. Since then, GTN has been a mainstay therapy for angina and cardiac failure, even with the possible loss of effectiveness (tolerance) over extended dosing [55] and the risk of platelet hyperactivity in GTN-tolerant patients [54]. Despite this venerable therapeutic history, the mechanism of GTN bioactivation to NO is speculative at best [38]. In 1967, some 15 years before identification of NO as a biological entity, GTN was the first nitrovasodilator shown... 

Exercise in not contraindicated in controlled angina. However, patients are advised to carry with them glyceryl trinitrate. Swimming is not associated with triggering of exercise-induced asthma. 

The drug nitroglycerin (glyceryl trinitrate), which is used in the treatment of angina pectoris, releases NO in the bloodstream and thereby leads to better perfusion of cardiac muscle. 

Mr AG, a 57-year-old taxi driver of Indian origin, attends your community pharmacy with a new prescription for glyceryl trinitrate (GTN) spray 400 micrograms - one or two puffs as required. You dispense this item and speak with him and he tells you that his GP thinks he has angina and has asked him to use the spray the next time he gets any minor chest pain or tightness. You counsel Mr AG on the correct use of the spray. 

Annie s doctor diagnoses angina and prescribes glyceryl trinitrate (GTN) tablets, which are to be dissolved under the tongue, not swallowed. 

This harm may be relatively trivial, as in hangover from an hypnotic or transient headache from glyceryl trinitrate used for angina. 

Patients suffering from angina pectoris should also use glyceryl trinitrate or isosorbide dinitrate as usual for pre-exertional prophylaxis 10 min before intercourse. They should be aware of the potentially fatal interaction of sildenafil (Viagra) with nitrates (see above, p. 545). 

Organic nitrates have been in use for over 135 years, and their adverse effects are therefore weU documented. The first compound of this class to be used was amyl nitrite, synthesized in 1844 by Ballard and used to treat angina pectoris by Brunton in 1869. Glyceryl trinitrate was first synthesized by Ascagne Sobrero in 1847 and was used by William Murrell to treat angina pectoris in 1879. 

In an assessment of how nitrate tolerance might be avoided, the efficacy of thrice-daily buccal glyceryl trinitrate and that of four times a day oral isosorbide dinitrate were compared (71) over 2 weeks, prolonged antianginal efficacy was maintained only with thrice-daily buccal administration. Nevertheless, in another study, transdermal glyceryl trinitrate seemed to offer a prolonged effect, sufficient to wean patients with unstable angina from intravenous nitrate therapy (71). 

Ethanol has also been implicated as the cause of acute gout in four patients with unstable angina who received intravenous infusions of glyceryl trinitrate (104). 

Glyceryl trinitrate patches for angina should be applied to the chest or upper arm. 

Allow the person to use any coronary vasodilator medication he or she is carrying. (If the individual has no medication but confirms that he or she has angina, you may give a glyceryl trinitrate tablet or similar medication.)... 

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