ATI Nitrates

What are the therapeutic uses of nitrates like nitroglycerin and isosorbide?

Treatment and prophylaxis of angina pectoris.

What forms of nitroglycerin are used to treat an angina attack?

Rapid-acting forms: transmucosal tablets, translingual spray, and sublingual tablets.

What is the purpose of IV nitroglycerin?

Used for severe unstable angina attacks, to control blood pressure perioperatively, and to treat heart failure after acute MI.

What are some adverse drug reactions of nitrates?

Severe headache, orthostatic hypotension, tachycardia, and quick development of tolerance.

What should a caregiver avoid when administering nitrate ointment?

Touching the ointment while applying.

What is a suggested intervention for a client experiencing headaches from nitrates?

Monitor the length and severity of the headache and suggest mild analgesics as needed.

What should be monitored when administering nitrates?

Baseline blood pressure and pulse, heart rate, and medication tolerance.

What is the recommended approach when giving nitroglycerin?

Administer the smallest needed amount and use intermittent scheduling for transdermal and long-acting forms.

What are the available forms of nitroglycerin?

Sublingual tablets, sustained-release capsules or tablets, translingual spray, transdermal ointment or patch, and IV form.

What are the types of isosorbide available?

Isosorbide dinitrate and isosorbide mononitrate.

How should sublingual tablets be administered?

Place under tongue to dissolve at the onset of chest pain.

If chest pain is not relieved after taking sublingual tablets, what should a client do?

Call 911 and take a second tablet, then a third tablet after 5 minutes if needed.

What should clients be informed about transdermal and transmucosal tablets?

Do not swallow; may need to moisten mouth to aid dissolution.

What is the storage recommendation for nitroglycerin tablets?

Store in a dark, tightly closed container for no more than 24 months after opening.

What should be done during the daily use of transdermal patches?

Remove for 10-12 hours to prevent tolerance.

How should topical nitroglycerin ointment be dosed?

Measured as the amount squeezed from the tube (e.g., 2 inches = 30 mg) and applied to dry skin.

What is crucial to do when discontinuing long-acting forms of nitrates?

Taper doses to prevent increased chest pain (vasospasm).

How is the IV form of nitroglycerin infused?

Continuously in a glass bottle with special tubing.

What should clients take for unrelieved headaches caused by nitroglycerin?

Over-the-counter analgesics.

What safety instructions should clients follow regarding dizziness?

Report dizziness and syncope to the provider and move slowly from lying down to sitting or standing.

What should clients do if they experience tachycardia while on nitrates?

Take pulse and report rates above prescribed parameters.

What are the contraindications for nitrates?

Allergy or tolerance to nitroglycerin or isosorbide, pregnancy, lactation, increased intracranial pressure, severe anemia, and more.

What precautions should be taken when using nitrates?

Head trauma, glaucoma, cardiomyopathy, severe liver disease, and conditions causing dry mouth.

What is the interaction effect of nitrates with antihypertensive medications?

Increased hypotension may result.

Which medications can cause severe hypotension when combined with nitrates?

Phosphodiesterase-5 (PDE5) inhibitors, such as sildenafil.

What effect do anti-cholinergic medications have on sublingual nitroglycerin?

They may decrease the absorption of sublingual nitroglycerin.

Why is tolerance a concern with nitrates?

Tolerance develops quickly, leading to decreased effectiveness.

What is the maximum number of sublingual sprays a client can take in a 15-minute period?

No more than 3 doses.

How should clients manage the usage of sublingual nitroglycerin tablets?

Take only as many as needed.

How should clients apply transdermal patches?

Apply to a hairless area and rotate sites.