Farmaci nitrati
Cosa sono i nitrati?
I nitrati sono farmaci antianginosi, che riducono il precarico e quindi il lavoro del miocardio, aumentano la perfusione miocardica per vasodilatazione. Il nitroprussiato sodico è uno dei trattamenti di prima scelta nella crisi ipertensiva.
Possono essere somministrati per diverse vie (percutanea, sublinguale, orale e endovenosa. Vi sono preparati ad azione rapida (NTG sublinguale, NTG intravenosa, nitroprussiato intravenoso) e preparati ad azione più lenta (NTG transfermica, mononitrato e isosorbide dinitrato per via orale). Il principale problema associato alla terapia cronica di questi farmaci è la tendenza a sviluppare tolleranza farmacologica( tachifilassi), essendo per questa ragione necessaria una somministrazione intermittente con un intervallo di sospensione giornaliera.
Meccanismo d’azione
Le basi biochimiche della loro attività vasodilatatoria risiedono nella liberazione di ossido nitrico (NO) e attraverso un aumento dei livelli di GMPc a livello della parete vascolare, riducono la concentrazione intracellulare di calcio, provocando una vasodilatazione prevalentemente venosa e in minor misura arteriosa.
Effetti collaterali
Cefalea, nausea, vomito ipotensione arteriosa, tachicardia riflessa, metaemoglobinemia. Il nitroprussiato oltre agli effetti collaterali descritti può provocare anche: acidosi lattica, accumulo di tiocianato e ipotiroidismo.
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