NITROGLYCERIN

BRAND NAMES:
Nitrostat, Nitroquick, Nitrolingual, Nitro-Dur, Minitran, Nitro-Bid

AVAILABLE FORMS:
Tablets: 0.3, 0.4, 0.6 mg;
Capsules: 2.5, 6.5, 9 mg; Spray: 0.4 mg/spray;
Transdermal Patch: 0.1, 0.2, 0.3, 0.4, 0.6, 0.8 mg/hour;
Ointment: 2%;
Injection: 100, 200, 400 mcg/ml;
Injection solution: 5 mg/ml.

INDICATIONS:
Treatment of angina pectoris; I.V. for congestive heart failure; pulmonary hypertension; hypertensive emergencies occurring perioperatively (especially during cardiovascular surgery).

ADVERSE REACTION:
Cardiovascular: Hypotension (infrequent), postural hypotension, crescendo angina (uncommon), rebound hypertension (uncommon), pallor, cardiovascular collapse, tachycardia, shock, flushing, peripheral edema
Central nervous system: Headache (most common), lightheadedness (related to blood pressure changes), syncope (uncommon), dizziness, restlessness
Gastrointestinal: Nausea, vomiting, bowel incontinence, xerostomia
Genitourinary: Urinary incontinence
Hematologic: Methemoglobinemia (rare, overdose)
Neuromuscular & skeletal: Weakness
Ocular: Blurred vision
Miscellaneous: Cold sweat

MECHANISM OF ACTION:
Nitroglycerin belongs to a class of drugs called nitrates. Nitroglycerin is used for the treatment and prevention of angina caused by coronary artery disease. A nitrate that reduces cardiac oxygen demand by decreasing left ventricular end-diastolic pressure (preload) and, to a lesser extent, systematic vascular resistant (after load). Nitroglycerin relaxes blood vessels allowing more blood to flow through and improves blood flow to the heart.

CONTRAINDICATIONS:
Hypersensitivity to organic nitrates; hypersensitivity to isosorbide, nitroglycerin, or any component of the formulation; concurrent use with phosphodiesterase-5 (PDE-5) inhibitors (sildenafil, tadalafil, or vardenafil); angle-closure glaucoma (intraocular pressure may be increased); head trauma or cerebral hemorrhage (increase intracranial pressure); severe anemia; allergy to adhesive (transdermal product)
Additional contraindications for I.V. product: Hypotension; uncorrected hypovolemia; inadequate cerebral circulation; constrictive pericarditis; pericardial tamponade

NURSING RESPONSIBILITY:
1.All formulations should be kept at room temperature, 15-30 C (59-86 F).
2.The sublingual tablets are especially susceptible to moisture. They should NOT be kept in bathrooms or kitchens because of the greater moisture in these rooms. Care should be taken to replace the sublingual tablets every six months.
3.Severe hypotension can occur. Use with caution in volume depletion, hypotension, and right ventricular infarctions.
4.Check or monitor vital signs and intensity or duration of drug response.
5.Advise patient who complains of a tingling sensation with SL drug to try holding tablet in buccal pouch.
6.Tell client to take oral tablet on an empty stomach either 30 minutes before or 1 to 2 hours after meals, to swallow oral tablets whole and not to chew tablets.
7.Advise client to avoid drinking alcohol.
8.To minimize orthostatic hypotension, tell patient to change to upright position slowly.