Everyone knows that nitroglycerin is a life-saving drug for angina sufferers, however did you know? Nitroglycerin is also a violent explosive. Invented by the University of Turin chemist Sobrero in 1847, but because of its chemical properties are not stable, can not be used at all. 1866, the Swedish chemist Nobel solved the problem of the stability of nitroglycerin, after the German Defense Explosive Pharmaceuticals Factory workers found that the headache disease, along with the entry of the factory’s work time, actually day by day to alleviate, which is only by chance to find the nitrate-based smoke dust on the role of the human body. First acquaintance with nitroglycerin Today, nitroglycerin has become the prevention and treatment of acute attacks of coronary heart disease, angina pectoris, the main drug. So, how did nitroglycerin come from the explosives factory into the pharmaceutical factory? Legend has it that in the 19th century, there was a production of nitroglycerin explosives in Britain, the chemical plant occurred one after another strange things: several usually strong as a cow workers weekend rest at home one after another sudden death, Scotland Yard immediately formed an investigation team to enter the factory to investigate, the results found that the original workers have long suffered from coronary heart disease. But because of the usual inhalation of nitroglycerin dust particles, the result is to make the heart coronary blood vessels can be dilated, myocardial blood supply and oxygen supply can be increased, so usually failed to find that they have the disease. Instead, their cause of death is weekend rest at home, failed to inhale nitroglycerin dust particles in time and the onset of disease. This startling discovery immediately attracted the attention of medical scholars. However, more than a hundred years later, three American scientists who won the 1998 Nobel Prize in Medicine discovered the mechanism of action of nitroglycerin and other organic nitrates: the release of nitric oxide (NO), which is able to dilate the smooth muscle of blood vessels to make blood vessels diastolic and thus conducive to blood circulation, the cardiovascular system to produce benefits. Nitroglycerin As mentioned above, the fundamental mechanism of nitroglycerin is the release of NO, which activates guanylate cyclase (cGMP) in vascular smooth muscle cells and platelets, increasing the formation of cGMP, which leads to vasodilatation of vascular smooth muscle and a decrease in blood pressure. Nitroglycerin predominantly dilates veins, and its intensity of action is dose-related. Dilatation of peripheral veins results in blood retention in the periphery, decreased return blood volume, and decreased left ventricular end-diastolic pressure (preload). Dilatation of arteries decreases peripheral resistance (afterload). Arteriolar dilation reduces myocardial oxygen consumption, thereby relieving angina. Thus the vasodilatory effect of nitroglycerin is now widely used in angina pectoris caused by coronary artery stenosis. Unique way of administration: Why sublingual? The capillaries under the tongue are very rich, and the oral mucosa absorbs the drug quickly, second only to the spraying method, in addition to avoiding the first gate elimination effect of the liver. Sublingual medication, the body should be leaning on the seat to take a sitting position or semi-sitting position (to prevent postural hypotension), directly under the tongue or chewed tablets placed under the tongue, the drug can be quickly disintegrated or dissolved, absorbed through the sublingual mucosa and play a rapid effect, contained in the tongue slightly burning sensation, which is precisely the characteristics of the drug is effective. If the mouth is dry, a small amount of water can be contained in the mouth, which is conducive to the dissolution and absorption of the drug. It should be noted that you can not eat candy like only the drug in the mouth, because the tongue surface of the tongue moss and cuticle is difficult to absorb the drug, and the sublingual mucosa in the rich venous plexus is conducive to the rapid absorption of drugs. Generally speaking, sublingual nitroglycerin is effective in 1 to 2 minutes, and the effect time can be maintained for 20 to 30 minutes. Why is drug resistance weakened? Multiple doses do produce drug resistance, so that the effectiveness of the drug is reduced, generally related to the following situations: 1, individual patients are sensitive to the drug, some patients are not sensitive to nitrates, easy to produce drug resistance; 2, the continued use of large doses of nitroglycerin; 3, long-term alcohol consumption or the use of sedative-hypnotic drugs, which increases the activity of the liver drug metabolism enzymes, resulting in drug resistance; 4, taking nitroglycerin while taking large doses of Weaken the vasodilator drugs, such as analgesic anti-inflammatory drugs. Nitroglycerin effect does not work, how to do? 1, small doses, intermittent medication, do not drink alcohol during the use of drugs; 2, timely change the type of nitroglycerin: such as oral medication, spray medication, etc.; 3, and other drugs used in combination to reduce the adverse effects, improve the efficacy of the drug.