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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