Betty Amah Linda Ngameduru Brenda Taft-Hall NURS 615

Nitroglycerin Classification
Classification

Cardiovascular Agent Antiangina

Subclass

Nitrate Vasodilator

Pharmodynamics
Trade Names and availability

Nitro-Bid IV, Nitrocap, Nitrodisc, Nitro-Dur Nitrogard, Nitroglyn, Nitrospan.

Transderm-Nitro
Nitrolingual

Pharmodynamics

Injection

Sublingual tablet

Buccal Tablets

Spray Translingual

Pharmodynamics

Extended Release Tablets

Ointment

Sustained Capsules

Transderm Patch

Pharmodynamics
Mechanism of action
Nitroglycerine is a potent vasodilator that relaxes the vascular smooth muscle by unknown mechanism. This results in dose related vasodilatation of the arteries and the veins. As a result, parts of the ventricular preload and afterload are reduced and myocardial oxygen demand is decreased.
(Wilson, Shannon, Shield, Stang, 2007)

Pharmodynamics

Metabolism - Liver Absorption Significant loss in first pass metabolism after oral dose.

Distribution- Widely distributed.

Breast milk- Unknown Onset 2 min. SL, 3 min. PO, 30 minutes ointment. Eliminated- Urine

Major DrugDrug Interactions

nitroglycerin tizanidine
nitroglycerin cloninidine nitroglycerin sildenafil

nitroglycerin vardenafil
nitroglycerin tadalafil

Nitroglycerin Hemodialysis

Nitrogylcerin and hemodialysis can cause life-threatening hypotension.

The medication should be withheld before dialysis.

Indications of Use

Acute Angina Hypertension Angina Prophylaxis

Indications of Use
Unlabeled Uses

Congestive Heart Failure Acute Myocardial Infarction Raynards Phenomenon Peripheral vascular Disease

Contraindications
Nitroglycerin contraindications in use Nitroglycerin contraindications in use

Hypersensitivity Idiosyncrasy

Head trauma Increased ICP

Tolerance to nitrates
Severe anemia

Glaucoma
Hypotension

Contraindications
Nitroglycerin contraindications in use Nitroglycerin contraindications in use

Conditions that cause dry mouth. Constrictive pericarditis Uncorrective Hypovolemia

Pericardial Tamponade Pregnancy and Lactation Expired medication

Precautions

Severe Liver Kidney Disease Conditions that cause dry mouth Early MI( Nausea, Vomiting)

Review of Literature

Accuracy and Precision of Metered Doses of Nitroglycerin Lingual Spray

Transdermal Patch Drug Delivery Interaction with Exercise.

Cardiac Patients Knowledge and Use of Sublingual glyceryl trinitrate (SLGTN)

Implementation Plan
Age

Elderly patients are more likely to have related diseases such as renal kidney problems. Caution and adjust dose for the patient. Children No studied have been established Older adults may have postural hypotension, so they need to be watched carefully.

Implementation Plan

Culture
Viagra should not be taken with any form of Nitroglycerin.

Long term use

Do not stop taking this drug abruptly

Edmunds & Mayhem, 2009

Implementation Plan

Patient must not smoke while using the drug Keep drug away fire (Highly Volatile) Take medication on an empty stomach Stop smoking Lifestyle modifications Avoid stressful situations

Implementation Plan

Avoid foods that stimulates the heart ex: coffee, tea, caffeinated drinks, chocolate.

Keep medication out the reach of children

If condition does not improve after three SL doses, seek emergency care or call 911.

Williamson, Owen D , 2011

Special Considerations

Store tablets in its original container Do not drink alcohol after taking this medication. Report any increase in use. Record and report. Refer patient to a cardiologist for evaluation and treatment Do not breastfeed while taking this drug without consulting physician.

Williamson, Owen D., 2011

Summary

In summary, nitroglycerin is available in many forms. It is used to treat acute angina, and early MI. The administration and use of this drug requires safe dosing and close monitoring. Proper storage, traveling and dispensing of nitroglycerin is recommended to avoid early deterioration of the drug.

Recommendation

American College of Cardiology/American Heart Association Task Force on Practice Guidelines for Chronic or Stable Angina American Heart Association American Cardiovascular Society American Academy of Family Physicians

Treatment Guidelines

References

Edmunds, M. W. & Mayheim, M. S. (2009). Pharmacology for the primary care provider . 3rd edition. St. Louis, MO: Mosby. Lenz, Thomas L., & Gillespie, Nicole. (2011). Transdermal patch dermal drug delivery interaction with exercise, Department of pharmacy practice, Sports Med 41 (3): 177-183 Ming-I Fan, MAP, MHSM, BS, RN, Clinical Research Associate, Clinical Research Department, Quality Clinical Research Co. Ltd. Retrieved April 10, 2012 http://www.ajan.com.au/Vol26/26-3_Fan.pdf National Institutes of Health. (2012). Nitroglycerin Transdermal. Retrieved April 10, 2012 www.nlm.nih.gov. Price, James W. , & Price, John R. (2008). Accuracy and precision of metered dose of nitroglycerin lingual spray, American Journal-Health system Pharmacy , Vol. 65 , 1557-1559 Williamson, Owen D., (2011). Topical nitroglycerin reduces pain during ADL in patients with chronic tendinopathies. ACP Journal Club, 154 , (2), p5-5

Thank You
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