Nitroglycerine Drug Study

In making a Drug Study, the following elements must be present: Generic Name and the Brand name (not all brands, just the brand used by the patient), Action, Indication, Pregnancy Category, Drug Classification, and Contraindication, Adverse Effect, Drug interaction and Nursing Consideration/Intervention…. Most clinical instructors preferred this to be in a long bond paper in printed or handwritten with paper in landscape.

Nitroglycerin

Pregnancy Category C

Drug classes: Antianginal agent, Nitrate

Therapeutic actions

Relaxes vascular smooth muscle with a resultant decrease in venous return and decrease in arterial BP, which reduces left ventricular workload and decreases myocardial oxygen consumption.

Indications

· Acute angina: sublingual, translingual preparations

· Prophylaxis of angina: oral sustained release, sublingual, topical, transdermal, translingual, transmucosal preparations

· Angina unresponsive to recommended doses of organic nitrates or beta-blockers (IV preparations)

· Perioperative hypertension (IV preparations)

· CHF associated with acute MI (IV preparations)

· To produce controlled hypertension during surgery (IV preparations)

· Unlabeled uses: reduction of cardiac workload in acute MI and in CHF (sublingual, topical); adjunctive treatment of Raynaud's disease (topical)

Contraindications

· Contraindicated with allergy to nitrates, severe anemia, early MI, head trauma, cerebral hemorrhage, hypertrophic cardiomyopathy, pregnancy, lactation.

Adverse effects

Headache, apprehension, restlessness, weakness, vertigo, dizziness, faintness

Tachycardia, retrosternal discomfort, palpitations, hypotension, syncope, collapse, orthostatic hypotension, angina

Rash, exfoliative dermatitis, cutaneous vasodilation with flushing, pallor, perspiration, cold sweat, contact dermatitis--transdermal preparations, topical allergic reactions--topical nitroglycerin ointment

Nausea, vomiting, incontinence of urine and feces, abdominal pain

Local burning sensation at the point of dissolution (sublingual)

Ethanol intoxication with high-dose IV use (alcohol in diluent)

Drug Interactions:

· Increased risk of hypertension and decreased antianginal effect with ergot alkaloids

· Decreased pharmacologic effects of heparin

Nursing considerations

· Give sublingual preparations under the tongue or in the buccal pouch. Encourage patient not to swallow. Ask patient if the tablet "fizzles" or burns. Always check the expiration date on the bottle; store at room temperature, protected from light. Discard unused drug 6 mo after bottle is opened (conventional tablets); stabilized tablets (Nitrostat) are less subject to loss of potency.

· Give sustained-release preparations with water; warn the patient not to chew the tablets or capsules; do not crush these preparations.

· Administer topical ointment by applying the ointment over a 6 × 6 inch area in a thin, uniform layer using the applicator. Cover area with plastic wrap held in place by adhesive tape. Rotate sites of application to decrease the chance of inflammation and sensitization; close tube tightly when finished.

· Administer transdermal systems to skin site free of hair and not subject to much movement. Shave areas that have a lot of hair. Do not apply to distal extremities. Change sites slightly to decrease the chance of local irritation and sensitization. Remove transdermal system before attempting defibrillation or cardioversion.

· Administer transmucosal tablets by placing them between the lip and gum above the incisors or between the cheek and gum. Encourage patient not to swallow and not to chew the tablet.

· Administer the translingual spray directly onto the oral mucosa; preparation is not to be inhaled.

· Arrange to withdraw drug gradually. 4–6 wk is the recommended withdrawal period for the transdermal preparations.