Nitrate, Antianginal

Question 1

Brand name for nitroglycerin?

Answer 1

Minitran, Nitrostat, Nitro-Dur

Question 2

Class?

Answer 2

nitrate, antianginal

Question 3

Dosage Form?

Answer 3

oral capsule ER, sublingual tablet, sublingual packet, sublingual solution, translingual aerosol, transdermal patch 24h, transdermal ointment, rectal ointment

Question 4

Indications?

Answer 4

Angina prophylaxis, Angina, acute, sublingual

anal fissure, chronic

Question 5

MOA?

Answer 5

Nitroglycerin is believed to be converted to nitric oxide (NO) by vascular endothelium. NO activates guanylate cyclase, increasing cyclic GMP that in turn decreases intracellular calcium, resulting in direct relaxation of vascular smooth muscle. In myocardial ischemia, nitrates dilate large epicardial vessels, enhance collateral size and flow, and reduce coronary vasoconstriction.

Question 6

Contraindication?

Answer 6

Hypersensitivity to nitrates, concurrent use with PDEIs, symptomatic hypotension, marked bradycardia or tachycardia, severe anemia or increased intracranial pressure

Question 7

Common ADRs?

Answer 7

Headache

Question 8

Less Common?

Answer 8

Bradycardia, drug tolerance, flushing, hypotension. light-headedness, nausea, orthostatic hypotension, vomiting

Question 9

Rare and serious?

Answer 9

Increased intracranial pressure, severe hypotension, syncope, methemoglobinemia

Question 10

Monitoring?

Answer 10

efficacy: Decreased use of sublingual nitroglycerin to treat anginal episodes, reduction in angina episodes, reduction in anginal pain.

Toxicity Monitoring Parameters. Signs/symptoms of hypotension, problematic headaches, or decreasing efficacy (drug tolerance). BP and HR.

Question 11

Key Patients Counseling Points?

Answer 11

Sit Prior to using sublingual tablets, lingual aerosol or spray.

Tablet should be dissolved under tongue or in buccal pouch at first sign of angina; do not swallow or chew tablet. Do not eat or drink after placement of tablets. Spray should be sprayed onto or under tongue; do not inhale; do not spit out or rinse mouth after use.

Rise slowly from a sitting position in order to prevent light-headedness. Allow a 10- to 12-h/d drug-free interval to avoid development of nitrate tolerance for both patches and extended-release capsules. Avoid concurrent use of alcohol, CNS depressants, antihypertensives, or other drugs that cause hypotension. Do not use with PDEIs, which may result in hypotension. The ointment may stain clothing. When treating acute angina, instruct patient to call 911 if symptoms are not resolved by the first dose.