Nitrates

Question 1

Nitrates Drug Names

Answer 1

Isosorbide dinitrate

Isosorbide mononitrate

Nitroglycerin

Question 2

Nitrates Therapeutic Actions

Answer 2

• Acts directly on smooth muscle to cause relaxation and depress muscle tone of blood vessels (major vasodilation)

Question 3

Nitrates Indications

Answer 3

• Prevention and treatment of attacks of angina pectoris

Question 4

Nitrates Contraindications and Cautions

Answer 4

Contraindication:
•	Allergy 
•	Severe anemia 
•	Head trauma or cerebral hemorrhage
•	Pregnancy and lactation

Caution: 
•	Hepatic or renal disease 
•	Hypotension 
•	Hypovolemia 
•	Conditions that limit cardiac output

Question 5

Nitrates DDI

Answer 5

DDI:
• Ergot derivatives
• Heparin
• Sildenafil, talafil, vardenafil (erectile dysfunction medication)

Question 6

Nitrates Adverse Effects

Answer 6

• CNS: (terrible) headache, dizziness, and weakness
• GI: nausea, vomiting
• CV: Hypotension
• Flushing, pallor increased perspiration

Question 7

Nitrates:

Assessments

Answer 7

Assess:
Hx: allergy, early MI, head trauma, cerebral hemorrhage, hypotension, hypovolemia, anemia, or low cardiac output, pregnancy or lactation
Physical: vital signs, weight, heart & lung sounds, skin, perfusion(pulses), skin condition (baseline)
Labs: CBC, hemoglobin & hematocrit, renal and hepatic functions

Question 8

Nitrates:

Diagnosis

Answer 8

Dx:

• Decreased cardiac output related to vasodilation and hypotensive effects
• Risk for injury related to CNS or CV effects
• Ineffective tissue perfusion related to hypotension or changes in cardiac output
• Deficient knowledge

Question 9

Nitrates:

Implementation

Answer 9

Implementation:
• Have the patient lay down or sit down prior to administration
• Give sublingual preparations under the tongue or in the buccal pouch
• SL does may be repeated 3 times, five minutes apart, if no relief they need to go to emergency room
• Give SR with water and don’t chew
• Have life-support equipment ready
• Provide thorough patient teaching

Question 10

Nitrates:

Evaluation

Answer 10

Eval:
Response to the drug
Adverse effects 
Effectiveness of comfort measures Compliance with the regimen
Effectiveness of the teaching plan