Nitrates

Nitrates MOA

• Dilates vascular smooth muscle

  • Venous and arterial vessels

• Venous dilatation 

  • Decreases the returning flow of blood to the heart

• Arterial dilatation

  • Reduces systemic vascular resistance

• overall nitrates just decreased the workload on the heart and it also decreased the need of the heart for oxygen

Nitrates Contraindications

• Allergies

• Hypersensitivity

• Severe anemia

• Increased intracranial pressure

• cerebral hemorrhage_____

Nitrates AE

• H/A

• tachycardia_____________________

• N/V

• Postural/Orthostatic hypotension

• Syncope = fainting 

• Opening vessels, will increase intracranial pressure 

• Medication will lead to Methemoglobinemia (hemoglobin is oxidized, can’t carry oxygen)

Nitrates AE

• Restlessness

• Palpitations

• Dizziness

• Abdominal  pain

• Cutaneous  flushing

Nursing Considerations

• Assess BP, P and R during initial therapy.

• Evaluate pain (0-10)

  • Time started.

  • Activity being performed.

  • Duration, severity and length. 

• Avoid activities that will elicit an attack:

  • Overexertion__________

  • Heavy meal (fat)

  • Emotional stress

  • Cold exposure _______

Monitor for adverse reactions

• H/A

• Lightheadedness

• ↓ BP

Educate Pt on 

• Adverse reactions.

• Dizziness-avoid hazardous activities.

• Seek medical care if anginal pain is not relieved by three tabs in 15 minutes (onset, 5minutes, 5 minutes)

  • After 2, if they still clenching chest, call 911 might be a heart attack 

• Change positions slowly.

• Viagra contraindicated. Viagra can lower the blood pressure, making the patient dizzy, lightheaded or faint. 

• In some cases, Viagra taken with nitrates has caused death. Patients should not take Viagra within 24 hours of taking nitrates. 

• Sublingual (under tongue)

• Brown container cause it sensitive to light 

Special Considerations:

• Alcohol may cause severe hypotension. 

• Anticholinergics

  • Delay sublingual absorption due to dryness of the mouth.

  • Example:  atropine-blocks cholinergic  receptors; increases HR in bradycardia.; decreases secretions. 

Nitroglycerin/Transdermal Patches

• Slow release

• Absorbed through the skin

• Effects begin within 30 to 60 minutes.

  • Persist up to 14 hours

• Apply once daily

  • Hairless area of skin

  • Rotate site to avoid irritation

• Tolerance can develop if used continually

• Patch free interval of ___10 to 12____ hours/day.