nitroglycerin Flashcards
1
Q
class
A
- organic nitrate
- antianginal
2
Q
trade names
A
- PO extended-release
- Nitro-Time
- SL tablet
- Nitrostat
- TL spray
- Nitrolingual
- Nitromist
- TD patch
- Nitro-Dur
- ointment
- Nitro-Bid
- IV
- Nitro-Bid IV
3
Q
other organic nitrates for angina
A
- SL: isosorbide dinitrate (Isordil)
- PO: isosorbide mononitrate (Imdur)
4
Q
uses
A
- Tx of acute attack
- prophylaxis of chronic stable or variant (Prinzmetal’s or vasospastic) angina
5
Q
AE
A
- HA
- orthostatic hypotension
- reflex tachycardia
- tolerance
6
Q
reflex tachycardia
A
various ANS effects → rapid sinus rhythm
7
Q
pt ed for nitroglycerin-induced HA
A
- use ASA or acetaminophen for pain
- lie down, rest in cool environment
- notify provider if persists for a few wks
8
Q
pt ed for orthostatic hypotension
A
- sit or lie down if dizzy or faint
- avoid sudden changes of position; rise slowly
9
Q
interventions for reflex tachycardia
A
- monitor VS
- give beta blocker if Sx occur
10
Q
pt ed/interventions to prevent nitroglycerin tolerance
A
- use lowest effective dose
- for long-acting forms: need med-free period daily
11
Q
contraindications for nitroglycerin
A
- hypersensitivity to nitrates
- traumatic head injury (can ↑ ICP)
12
Q
precautions for nitroglycerin
A
- use of antihypertensives
- renal or liver dysfunction
- pregnancy category C
13
Q
interactions
A
- ETOH
- antihypertensives
- PDE5 inhibitors
14
Q
ETOH + nitroglycerin =
A
- ↑ hypotensive effect
- avoid ETOH
15
Q
antihypertensives + nitroglycerin =
A
- ↑ hypotensive effect
- drugs include
- beta blockers
- Ca channel blockers
- diuretics
- use cautiously
16
Q
PDE5 inhibitors + nitroglycerin =
A
- possible life-threatening hypotension
- do not take together
- drugs include
- sildenafil (Viagra)
- tadalafil (Cialis)
- vardenafil (Levitra)
17
Q
SL and TL info
A
- onset: rapid
- duration: duration
- use: Tx or prophylaxis of acute attack
18
Q
SL and TL admin/pt ed
A
- 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
19
Q
- info/pt ed for
- extended-release PO
- TD patch
- ointment
A
- 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
20
Q
extended-release PO admin/pt ed
A
- swallo whole
- do not crush or chew
- take on empty stomach with ≥ 8 oz water
21
Q
TD admin/pt ed
A
- 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
22
Q
ointment admin/pt ed
A
- 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)
23
Q
IV use
A
- control ov angina not responding to other meds
- control of BP or induced hypotension during surgery (↓ blood loss)
- HF from acute MI
24
Q
IV admin/pt ed
A
- 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
25
SL and TL instructions for Tx of acute angina attack
* (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**
