Nitrates

Nitrates are a group of drugs that act on blood vessels and dilate them. They are used to relieve angina (chest pain caused by cardiac ischemia - reduced blood supply to the heart). By relaxing smooth muscle in the vessel wall, they produce an increase in diameter, which in turn increases the volume of blood flowing through the coronary arteries and stop chest pain.

Nitrates are available in different formulations including:

• Sustained release tablets and capsules (Imdur, Isordil)
• Ointments (Nitral®, Nitro-bid®)
• Patches worn on the skin (Deponit ntg®, Minitron®, Nitrodisc®, Nitrodur®, transderm Nitrol®)
• Injections (Nitrobid IV®, Nitrostat IV®, Tridil®)
• Quick-release tablets (Nitrostat®).
• Spray

These drugs should be used cautiously, since they can severely reduce blood pressure.

Following a heart attack, a patient will usually receive nitroglycerin, first under the tongue and then, if necessary, intravenously. It also is used for people with chronic, stable angina and as needed to relieve episodes of angina pain.

Patients using nitrates must avoid using other medications that may lower blood pressure, including medications for erectile dysfunction, due to the risk of dangerously low blood pressure.

Morphine is a narcotic that not only relieves pain and reduces anxiety but it also dilates blood vessels, thereby aiding the circulation of blood and oxygen to the heart. Morphine can decrease blood pressure and slow down the heart, however, which may worsen heart attacks for some patients.

Other drugs such as meperidine (Demerol®) or nalbuphine (Nubain®) also may be used for pain relief during a heart attack or acute coronary syndrome.