Nitrates

Question 1

Nitrates action

Answer 1

Act directly on smooth muscle to cause relaxation & depress muscle tone of blood vessels
Cause significant vasodilation (leads to hypotension)

Question 2

Nitrates drug names

Hint: end “nitrate” or “nitro”

Answer 2

Isosorbide dinitrate (preventative oral take everyday)
Isosorbide monoitrate (preventative oral take everyday)
Nitroglycerin (as needed sublingual; take at 1st sign of chest pain)

Question 3

Nitrates contraindications

Answer 3

Allergy
Severe anemia (↓ oxygen already lower BP)
Head trauma or cerebral hemorrhage (leads to more bleeding)
Pregnancy
lactation

Question 4

Nitrates caution

Answer 4

Hepatic/Renal disease (need dose adjustment)

Hypotension, hypovolemia & conditions that limit cardiac output

Question 5

Nitrates indications

Answer 5

Prevention & Tx of attacks of angina pectoris

Question 6

Nitrates Drug-drug interactions

Answer 6

Ergot derivatives (Vasoconstriction ↑ BP will ↓ the effects of antianginal meds)
Heparin (↓ in heparin effects)
Sildenafil, tadalafil & Vardenafil (erectil dysfunction meds causes vasodilation)
Ask if taken within the last 24 hrs (Cardiovascular colapse)
DO NOT GIVE A NITRATES MED

Question 7

Nitrates adverse effects

Answer 7

Related to the vasodilation & decreased in blood flow
CNS: Headache (very intense), dizziness, & weakness
GI: N & V
CV: Hypotension
Misc: Flushing, pallor, increased perspiration

Question 8

Nitrates nursing implications

Answer 8

HX of allergies, past medical
Head trauma, cerebral hemorrhage, early MI, hypotension, hypovolemia, anemia, low-cardiac-output
Pregnancy & lactation status
Baseline of skin: color & diaphoresis
Know about pain, location, radiate, intensity (0-10 scale) when did it start, how long is it being going on what have you done to relief chest pain
Lung sounds & assess respirations
BP, HR, Heart sounds, edema, palpate pulses, baseline ECG
Labs: CBC; hemoglobin & hematocrit detect anemia; potential bleeding
Liver/kidney fxn (hypovolemic or not)
Sit down or lay down before admin
Sublingual can be repeated in 5 min; total 3 doses; no relief need to go to ED
Translingual spray under tongue
Have emergency life-support readily available
Taper dose gradually after long & term

Question 9

Nitrates prototype

Answer 9

Nitroglycerin

Question 10

Nitroglycerin action

Answer 10

relaxes vascular smooth muscle with a resultant ↓ in venous return
Vasodilation = improve blood flow to the myocardium
↓ workload of left ventricle by causing vasodilation

Question 11

Nitroglycerin adverse effects

Answer 11

Hypotension
Headache
dizziness
tachycardia
rash
flushing
N & V
sweating 
chest pain

Question 12

Nitrates indications

Answer 12

Acute angina