TABLE 12-2 Beneficial and deleterious effects of nitrates in the treatment of angina. Effect Mechanism and Result Potential beneficial effects Decreased ventricular volume Decreased work and myocardial Decreased arterial pressure oxygen requrement Decreased ejection time Vasodilation of epicardial Relief of coronary artery spasm coronary arteries Increased collateral flow Improwed perfusion of ischemic myocardium Decreased left ventricula Improved subendocardial diastolic pressure rfusion Potential deleterious effects Reflex tachycardia Increased myocardial oxygen requirement: decreased diastolic rfusion time and coronary perfusi Reflex increase in contractility Increased myocardial oxygen requirement
TABLE 12-3 Nitrate and nitrite drugs used in the treatment of angina Drug Dose Duration of Action Short-acting 0.15-1.2 isosorbide dinitrate, sublingual 25-5mg 10-60 minutes Amyl nitrite, inhalant 0.18-03mL 3-5 minutes Long-actin Nitroglycerin, oral sustained-action 6.5-13 mg per 6-8 hours 6-8 hours Nitroglycerin, 2% ointment, transdermal 1-15 inches per 4 hours 3-6 hours Nitroglycerin, slow-release, buccal 1-2 mg per 4 hours 3-6 hours Nitroglycerin, slow-release patch, transdermal 10-25 mg per 24 hours(one patch per day) 8-10 hours Isosorbide dinitrate, sublingual 2.5-10 mg per 2 hours 15-2 hours Isosorbide dinitrate, oral 10-60 mg per 4-6hours 4-6 hours Isosorbide dinitrate chewable oral 5-10 mg per 2-4 hours 2-3 hours Isosorbide mononitrate, oral 20 mg per 12 hours 6-10 hours Pentaerythritol tetranitrate(PETN) 50 mg per 12 hours 10-12 hours