nitrate – n. 硝酸盐
amyl nitrate – n. 亚硝酸异戊酯
isosorbide – n. 异山梨醇
dinitrate – n. 二硝基盐
isosorbide dinitrate – n. 硝酸巨星山梨酯
Isordil – n. 【奥】异山地尔
mononitrate – n. 单硝酸盐
isosorbide mononitrate – n. 单硝酸异山梨酯
Monoket – n. 【奥】蒙诺凯特
nitroglycerin – n. 硝酸甘油
Nitro-Bid – n. 【奥】耐比特
Nitrostat – n. 耐绞宁
sublingual – a. 舌下的
translingual – a. 经舌的
transdermal – a. 经皮的
topical – a. 局部外用的
transmucosal – a. 经粘膜的 注：带“【奥】”标记者为奥医临时用名，只为方便学员复习记忆，不得作为临床诊疗依据！
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Nitrates 硝酸盐类
Nitrates are drugs that act directly on smooth muscle to cause relaxation and to depress muscle tone. Because the action is direct, these drugs do not influence any nerve or other activity, and the response is usually quite fast. Nitrates include amyl nitrate (generic), isosorbide dinitrate (Isordil), isosorbide mononitrate (Monoket), and nitroglycerin (Nitro-Bid, Nitrostat, and others).
The nitrates relax and dilate veins, arteries, and capillaries, allowing increased blood flow through the vessels and lowering systemic blood pressure because of a drop in resistance. Because CAD causes a stiffening and lack of responsiveness in the coronary arteries the nitrates probably have very little effect on increasing blood flow through these arteries. However, they do increase blood flow through healthy coronary arteries. Therefore, the blood supply through any healthy vessels in the heart increases, possibly helping the heart to compensate somewhat.
The main effect of nitrates, however, seems to be related to the drop in blood pressure that occurs. The vasodilation causes blood to pool in veins and capillaries, decreasing preload, while the relaxation of the vessels decreases afterload. The combination of these effects greatly reduces the cardiac workload and the demand for oxygen, thus bringing the supply-and-demand ratio back into balance. Nitrates are indicated for the prevention and treatment of attacks of angina pectoris.
Nitroglycerin is available as a sublingual tablet, a translingual spray, an IV solution (for bolus injection or infusion), a transdermal patch, a topical ointment or paste, or a transmucosal agent. It can be carried with the patient, who then can use it when the need arises. Slow-release forms also are available for use in preventing anginal attacks.
1. A nurse is instructing a client about the use of nitroglycerin patches. The nurse should instruct the client to:
A. Remove the patch every night.
B. Use the patch only when chest pain occurs.
C. Change the site of the patch every day.
D. Apply the patch only on alternate days. 2. The client who experiences angina has been told to follow a lowcholesterol diet. Which of the following meals would be best?
A. Hamburger, salad, and milkshake.
B. Baked liver, green beans, and coffee.
C. Spaghetti with tomato sauce, salad, and coffee.
D. Fried chicken, green beans, and skim milk.
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答案Answers
1. A. Remove the patch every night. Rationale: The client may become tolerant of the antianginal effects of nitrates. Removing nitrates for 8 hours each day is usually effective in preventing tolerance. Nitrate patches should not be used on an as-needed basis. Sites should be rotated daily to prevent skin irritation, but this is not related to tolerance. Removing the patch for only 8 hours is sufficient to prevent tolerance and skipping days could impact the drug's effectiveness. 2. C. Spaghetti with tomato sauce, salad, and coffee. Rationale: Pasta, tomato sauce, salad, and coffee would be the best selection for the client following a low-cholesterol diet. Hamburgers, milkshakes, liver, and fried foods tend to be high in cholesterol.
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