Nitric oxide donor
- ↑ cGMP → smooth-muscle relaxation
- Venodilation → ↓ preload → antianginal
- Headache and hypotension
- Tolerance with continuous exposure
- Catastrophic hypotension with PDE5 inhibitors
Drugs with this mechanism (5)
- Amyl nitrite — Inhaled nitrate vasodilator ("popper"); a nitric-oxide donor.
- Isosorbide dinitrate — Longer-acting oral nitrate; needs a nitrate-free interval to avoid tolerance.
- Isosorbide mononitrate — Long-acting oral nitrate for angina prophylaxis.
- Nitroglycerin — Fast-acting nitrate vasodilator; sublingual rescue for angina.
- Nitroprusside — Seconds-fast BP control that metabolizes to cyanide.
Self-check
- Why does NO-donor venodilation relieve angina?
It lowers preload. - Which drug class can cause catastrophic hypotension with NO donors?
PDE5 inhibitors.
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