nitroglycerin

Question 1

class

Answer 1

• organic nitrate
• antianginal

Question 2

trade names

Answer 2

• PO extended-release
  
  • Nitro-Time
• SL tablet
  
  • Nitrostat
• TL spray
  
  • Nitrolingual
  • Nitromist
• TD patch
  
  • Nitro-Dur
• ointment
  
  • Nitro-Bid
• IV
  
  • Nitro-Bid IV

Question 3

other organic nitrates for angina

Answer 3

• SL: isosorbide dinitrate (Isordil)
• PO: isosorbide mononitrate (Imdur)

Question 4

uses

Answer 4

• Tx of acute attack
• prophylaxis of chronic stable or variant (Prinzmetal’s or vasospastic) angina

Question 5

AE

Answer 5

• HA
• orthostatic hypotension
• reflex tachycardia
• tolerance

Question 6

reflex tachycardia

Answer 6

various ANS effects → rapid sinus rhythm

Question 7

pt ed for nitroglycerin-induced HA

Answer 7

• use ASA or acetaminophen for pain
• lie down, rest in cool environment
• notify provider if persists for a few wks

Question 8

pt ed for orthostatic hypotension

Answer 8

• sit or lie down if dizzy or faint
• avoid sudden changes of position; rise slowly

Question 9

interventions for reflex tachycardia

Answer 9

• monitor VS
• give beta blocker if Sx occur

Question 10

pt ed/interventions to prevent nitroglycerin tolerance

Answer 10

• use lowest effective dose
• for long-acting forms: need med-free period daily

Question 11

contraindications for nitroglycerin

Answer 11

• hypersensitivity to nitrates
• traumatic head injury (can ↑ ICP)

Question 12

precautions for nitroglycerin

Answer 12

• use of antihypertensives
• renal or liver dysfunction
• pregnancy category C

Question 13

interactions

Answer 13

• ETOH
• antihypertensives
• PDE5 inhibitors

Question 14

ETOH + nitroglycerin =

Answer 14

• ↑ hypotensive effect
  
  • avoid ETOH

Question 15

antihypertensives + nitroglycerin =

Answer 15

• ↑ hypotensive effect
• drugs include
  
  • beta blockers
  • Ca channel blockers
  • diuretics
• use cautiously

Question 16

PDE5 inhibitors + nitroglycerin =

Answer 16

• possible life-threatening hypotension
• do not take together
• drugs include
  
  • sildenafil (Viagra)
  • tadalafil (Cialis)
  • vardenafil (Levitra)

Question 17

SL and TL info

Answer 17

• onset: rapid
• duration: duration
• use: Tx or prophylaxis of acute attack

Question 18

SL and TL admin/pt ed

Answer 18

• use at first sign of CP
• use before activity known to cause CP
• store in cool, dark place
• keep handy
• tablet
  
  • place under tongue and let dissolve
  • do not crush or chew
• spray: against oral mucosa; do not inhale

Question 19

• info/pt ed for
  
  • extended-release PO
  • TD patch
  • ointment

Answer 19

• onset: slow
• duration: long
• use: long-term prophylaxis against angina attacks
• pt ed
  
  • do not stop taking abruptly
  • record pain frequency, intensity, duration, and location
  • notify provider if attacks increase in frequency, intensity, or duration

Question 20

extended-release PO admin/pt ed

Answer 20

• swallo whole
• do not crush or chew
• take on empty stomach with ≥ 8 oz water

Question 21

TD admin/pt ed

Answer 21

• to ensure appropriate dose, do not cut patches
• placement
  
  • on hairless area (chest, back, or abd)
  • not in skin fold
  • rotate sites to prevent skin irritation
• replacement
  
  • at night: remove old patch to ensure 10-12 hrs/day med-free (to ↓ risk of tolerance)
  • morning
    
    • wash skin with soap and water and dry thoroughly
    • place new patch

Question 22

ointment admin/pt ed

Answer 22

• remove prior dose before reapplying
• measure with applicator paper
• spread over 2.5–3.5 in. of paper
• apply to clean, hairless area
• cover with clear plastic wrap
• rotate sites to prevent skin irritation (chest, back, abd)
• avoid touching ointment with hands (gloves)

Question 23

IV use

Answer 23

• control ov angina not responding to other meds
• control of BP or induced hypotension during surgery (↓ blood loss)
• HF from acute MI

Question 24

IV admin/pt ed

Answer 24

• give with manufacturer-supplied IV tubing from glass IV bottle
• continuous infusion b/c of short duration
• rate
  
  • start slow (5 mcg/min)
  • titrate gradually until desired response achieved
• continuous cardiac monitoring

Question 25

SL and TL instructions for Tx of acute angina attack

Answer 25

* (dose = one TL spray or one SL tab) * **at first sign of CP** * **stop activity** * **sit or lie down** * immediately take one dose * **rest for 5 min.** * **if not relieved** * **call 911** * **take a second dose** * **rest 5 more min.** * ​still not relieved * **take third dose** * **​DO NOT TAKE MORE THAN 3 DOSES**