Mechanism of action using cGMP as second messenger
1. Cyclic GMP is formed from GTP by the action of the enzyme guanylate cyclase
2. Membrane bound guanylate cyclase is activated by atrial natriuretic factor (ANF), leading to effects like natriuresis, diuresis, inhibition of aldosterone secretion, and vasodilatation
3. Soluble guanylate cyclase is activated by compounds like nitroprusside, nitroglycerin, nitric oxide and sodium nitrate, leading to smooth muscle relaxation and vasodilation
4. cGMP activates cGMP-dependent protein kinase (PKG) which phosphorylates smooth muscle proteins like myosin light chain