N12: Nitroglycerin Flashcards

Questions and Answers

What are the therapeutic and pharmacologic classifications for nitroglycerin?

Therapeutic: antianginals; Pharmacologic: nitrates.

Is nitroglycerin safe for pregnant women?

False

Is nitroglycerin a high-alert medication?

False

What are the indications for nitroglycerin?

Management of angina pectoris, adjunct treatment of heart failure, and controlled hypotension during surgical procedures. Signup and view all the answers

What is the action and therapeutic effect of nitroglycerin?

Increases coronary blood flow, produces vasodilation, decreases left ventricular end-diastolic pressure, and reduces myocardial oxygen consumption. Signup and view all the answers

How is nitroglycerin metabolized?

Rapidly and almost completely by the liver and also by enzymes in the bloodstream. Signup and view all the answers

What is the half-life of nitroglycerin?

1-4 min. Signup and view all the answers

When is nitroglycerin contraindicated?

Hypersensitivity, severe anemia, pericardial tamponade, constrictive pericarditis, alcohol intolerance, and concurrent use of PDE-5 inhibitors. Signup and view all the answers

When should nitroglycerin be used cautiously?

In cases of head trauma, glaucoma, hypertrophic cardiomyopathy, severe liver impairment, and during cardioversion. Signup and view all the answers

What are the side effects/adverse reactions of nitroglycerin?

Dizziness, headache, blurred vision, hypotension, tachycardia, abdominal pain, and contact dermatitis. Signup and view all the answers

What are drug-drug interactions of nitroglycerin?

Concurrent use with PDE-5 inhibitors increases risk of hypotension; additive effects with antihypertensives and alcohol. Signup and view all the answers

What is the PO dosage for nitroglycerin?

2.5-9 mg every 8-12 hours. Signup and view all the answers

What is the IV dosage for nitroglycerin, and what is the max dose?

5 mcg/min, max: 200 mcg/min. Signup and view all the answers

How long should a nitroglycerin transdermal patch be worn?

12-14 hours a day, taken off for 10-12 hours. Signup and view all the answers

How often can a patient take a sublingual dose of nitroglycerin during an acute attack?

Every 5 minutes for a total of 2 additional doses. Signup and view all the answers

Can nitroglycerin be used prophylactically?

True Signup and view all the answers

What should the nurse monitor before and after nitroglycerin administration?

Blood pressure and pulse; continuous ECG monitoring for IV administration. Signup and view all the answers

What are lab test considerations for nitroglycerin?

May cause an increase in urine catecholamines and urine vanillylmandelic acid levels. Signup and view all the answers

Study Notes

Therapeutic Classifications

Therapeutic classification: antianginals
Pharmacologic classification: nitrates

Pregnancy Safety

Pregnancy Category C indicates risk not ruled out for nitroglycerin
Adverse effects observed in animal studies; lack of well-controlled studies in pregnant women

Alert Status

Nitroglycerin is not classified as a high-alert medication

Indications

Used for acute and long-term management of angina pectoris
Administer via translingual, sublingual, oral, ointment, or transdermal forms
Adjunct treatment for heart failure (HF) and acute myocardial infarction (MI)
Promotes controlled hypotension during surgery

Mechanism of Action

Dilates coronary arteries to increase blood flow and improve collateral flow to ischemic regions
Produces greater venous than arterial vasodilation
Decreases left ventricular end-diastolic pressure and volume, thus reducing myocardial oxygen consumption

Pharmacokinetics

Rapid metabolism occurs primarily in the liver, with some metabolism by bloodstream enzymes
Half-life ranges from 1 to 4 minutes

Contraindications

Avoid in hypersensitivity, severe anemia, pericardial tamponade, constrictive pericarditis, and large IV doses in alcohol intolerance
Contraindicated with PDE-5 inhibitors like sildenafil, tadalafil, and vardenafil due to risk of serious hypotension

Cautionary Use

Use cautiously in patients with head trauma, glaucoma, hypertrophic cardiomyopathy, severe liver impairment, and certain hemodynamic instabilities
Patch should be removed before cardioversion to avoid complications
Safety during pregnancy, lactation, and pediatrics not established

Side Effects and Adverse Reactions

Common CNS side effects: dizziness, headache, weakness, restlessness
Cardiovascular effects: hypotension, tachycardia, syncope
Gastrointestinal effects: abdominal pain, nausea, vomiting
Dermal effects: contact dermatitis from transdermal application
Risk of tolerance, flushing, and alcohol intoxication with large IV doses

Drug Interactions

Concomitant use with any form of nitrates and PDE-5 inhibitors increases the risk of serious hypotension
Can cause additive hypotension with antihypertensives, alcohol, beta blockers, calcium channel blockers, and certain antipsychotics
Anticholinergic drugs may also affect the absorption of translingual and sublingual nitroglycerin

Dosage Information

Oral dosage for adults: 2.5-9 mg every 8-12 hours
IV dosage for adults: start at 5 mcg/min, with potential increases based on hemodynamic response (max: 200 mcg/min)
Transdermal patch should be worn for 12-14 hours and then removed for 10-12 hours

Dosing During Acute Attacks

Sublingual doses can be repeated every 5 minutes, up to two additional doses, during an acute attack

Prophylaxis

Nitroglycerin may be administered 5-10 minutes before activities that could precipitate an angina attack

Monitoring

Monitor blood pressure and pulse before and after administration
Continuous ECG and BP monitoring required for patients receiving IV nitroglycerin

Laboratory Considerations

Administration may lead to increased urine catecholamines and other specific lab test indicators

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Description

Test your knowledge on nitroglycerin with these flashcards. Dive into its therapeutic and pharmacologic classifications, as well as safety considerations during pregnancy. Perfect for anyone studying pharmacology or healthcare.