References
GLYCERYL TRINITRATE
Abstract
In this column, Sharon Rees aims to refresh knowledge and interest in some of the commonly used drugs in a series of tweets. This month she is talking about #glyceryltrinitrate
Dr Sharon Rees @reesprescribe
Day 1: Discovered in 1847 as an early explosive, #glyceryltrinitrate, or GTN (also known as nitroglycerin) was used in blasting and smokeless gunpowder. In the UK, interest in amyl nitrite (no prescription use now) led to GTN usage for angina from 1867 (stable in solid medicinal form)
Dr Sharon Rees @reesprescribe
Day 2: #glyceryltrinitrate is a potent vasodilator. UK uses include angina treatment and prophylaxis, control of myocardial infarction and hypertension for cardiac surgery, anal fissure and prophylaxis of phlebitis (transdermal). Longer-acting nitrate agents can also treat left ventricular heart failure
Dr Sharon Rees @reesprescribe
Day 2 (cont): Sub-lingual spray 400mcg x 1-2/no more than three uses (shelf-life ~3yrs), sub-lingual tablet 300-600 mcg every 5 minutes up to 3 doses (tablets expire 8 weeks after opening), iv infusion 10-200 mcg/minute
Dr Sharon Rees @reesprescribe
Day 3: MOA #glyceryltrinitrate. Once in smooth muscle cells, denitration leads to release of nitric oxide. This activates guanylate cyclase and increases cGMP. Less Ca+ into cell allows smooth muscle relaxation. Powerful venodilation lowers cardiac preload. At higher doses, coronary artery vasospasm is relieved and there is lower afterload. All actions lower oxygen demand and relieve anginal pain
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