Nitrates

Cardiovascular

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Examples

nitroglycerinisosorbide dinitrate

Prefix / Suffix: nitro-

Physiology

Nitrates act on vascular smooth muscle, mainly causing venous dilation, which reduces blood returning to the heart and lowers cardiac workload.

Mechanism of Action

They release nitric oxide, leading to smooth muscle relaxation and vasodilation, especially of veins, reducing preload.

Indications

Angina
Acute coronary syndrome
Heart failure

Side Effects / Adverse Effects

Headache (due to cerebral vasodilation)
Hypotension (due to reduced preload)
Reflex tachycardia (compensatory response to low BP)
Dizziness

Contraindications

Severe hypotension
Use with sildenafil or similar PDE-5 inhibitors
Increased intracranial pressure

Nursing Considerations

Check BP before giving; hold if systolic < 90 mmHg (risk of severe hypotension)
For sublingual: give every 5 minutes, max 3 doses, then seek emergency care (standard angina protocol tested in exams)
Ensure patient is seated or lying down before administration (prevents syncope from sudden BP drop)
Do not give with PDE-5 inhibitors such as sildenafil (can cause life-threatening hypotension)
Provide nitrate-free interval (10–12 hours daily) for long-term use (prevents tolerance)

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Disclaimer: PharmPal Nurse is for education only and is not medical advice. Do not use it to diagnose, treat, prescribe, or make patient-care decisions; always verify with current drug references, your instructor, facility policy, and a licensed provider. In emergencies, call local emergency services.