Nitroglycerine Drug Study

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. 46 wk is the recommended withdrawal
period for the transdermal preparations.