Nitrates Drugs

Nitroglycerin (Nitrostat, Nitro-Bid) MOA

MOA: Causes smooth muscle relaxation and vasodilation in peripheral arteries and veins

Use: Acute angina

Hypertension

Acute decompensated heart failure (fluid overload without hypotension)

Reduce volume of blood coming back to the heart so the heart isn’t having to work as hard.

Sublingual/Translingual spray. Topical ointment, Topical patch, ER Capsule, IV

Nitroglycerin (Nitrostat, Nitro-Bid) Administration considerations Sublingual powder

We want to empty the packet under the tongue, close mouth, breath normally. Allow powder to dissolve. DO NOT RINSE OR SPIT FOR 5 MINUTES AFTER ADMINISTRATION

Nitroglycerin (Nitrostat, Nitro-Bid) Administration considerations Sublingual tablet

Do not crush, chew, or swallow. Place it under tongue or in cheek and allow to dissolve.

Nitroglycerin (Nitrostat, Nitro-Bid) Administration considerations Topical Ointment

Use dose measuring paper. Apply to clean, dry, and hair free area on chest or back. Secure with tape. Allow for nitrate-free intervals (Patients develop tolerance to it so you want to give them chunks of time when they are not getting it)

For example, giving it at 6AM then changing it at 12PM

Nitroglycerin (Nitrostat, Nitro-Bid) Administration considerations Translingual spray

Do not shake. Prime pump before initial use. Spray on to or under tongue. Do not inhale spray. Do not rinse mouth for 5-10 minutes after administration

Nitroglycerin (Nitrostat, Nitro-Bid) Administration considerations IV

Requires glass bottle or special container and special tubing

How to administer nitroglycerin - Patient education

If you are outside of the hospital setting, you will give 1 dose (sit or lay down) and wait 5 minutes

If pain does not improved then take 2nd dose (sit or lay down) and call 911

Take 3rd dose (sit or lay down) if EMS not arrived

Container is brown and pills are sensitive to light - once opened, they are stable for 6 months

Slidenafli, tadoalafil, and vardenafil all can cause hypotension with nitro (erectile dysfunction meds)

Nitroglycerin (Nitrostat, Nitro-Bid) A/E

Headache

Hypotension

Dizziness

Syncope

DO NOT TAKE WITH PHOSPHODIESTERASE 5 (PDE5) INHIBITOR

Avoid in hypotension

Isosorbide dinitrate (Isordil) Use

Prevention of angina pectoris

PO

Tolerance may develop with chronic use

Therefore, do not administer around the clock. Special dosing

Isosorbide dinitrate (isordil) A/E

Hypotension

Rebound hypertension (if they suddenly stop taking this medication after being on it, they might get hypertension again)

Headache

Educate on dosing schedule

Dihydropyridine (Nifedipine, amlodipine, nicardipine) MOA

Calcium Channel Blocker

DO NOT WORK ON THE CONDUCTION LIKE DILTIAZEM

MOA: Inhibits calcium ion influx across cardiac and smooth muscle. Results in muscle relaxation and vasodilation

Use: Angina (dilates coronary arteries)

Hypertension

Dihydropyridine Calcium Channel Blocker A/E

Headache

Gingival hyperplasia

Constipation

Peripheral edema

Dizziness

Hypotension