Drug class: Nitrate

Question 1

Drug

Answer 1

Nitroglycerin

Question 2

MOA

Answer 2

Dilates veins (at higher doses it can dilate arteries)
Increases supply to the heart by increasing preload

Question 3

Indication

Answer 3

Acute angina (first line)
Heart failure

Question 4

SE/AE

Answer 4

Headache
Orthostatic hypotension
Reflex Tachycardia (Think about the patient suddenly becoming hypovolemic because the vessels are now dilated with the same amount of fluid)

Question 5

Routes

Answer 5

Sublingual
Transdermal
IV
PO

Wear gloves when handling transdermal med - will absorb into the skin

Typically 400 mcg q5 mins up to 3 doses

Question 6

Contraindication

Answer 6

Any patient who has taken sildenafil, vardenafil, or tadalafil within previous 48-72 hrs (Causes hypotensive crisis)
Patients with suspected acute RV MI, closed angle glaucoma
BP under 90/60 prior to admin

Question 7

Nursing intervention

Answer 7

Resulting hypotension treated with fluids
Assess BP/HR prior to admin to prevent hypotension
Beta blocker/calcium channel blocker to suppress tachycardia

Question 8

Patient teaching

Answer 8

OTC meds for unresolved headache
Rise from sitting position slowly
Take as little as needed