Nitroglycerin

1. Action

A. It relaxes smooth muscle.

B. It dilates the blood vessels, which increases oxygen and blood to the heart.

C. It reduces the workload on the heart.

2. Possible Adverse Reactions

A. Headache, sometimes throbbing.

B. Dizziness.

C. Palpitations.

D. Flushing.

E. Orthostatic hypotension (drop in blood pressure upon rising).

F. Fast heart rate.

G. Weakness.

H. Nausea and vomiting.

I. Sublingual burning.

3. Administration

A. Sublingual.

i. Place tablet under tongue at the first sign of an attack.

ii. Take one tablet every five minutes, up to three tablets as needed.

iii. If pain is not relieved after three tablets, get medical attention.

B. Oral.

i. Take on an empty stomach (one-half hour before or 2 hours after meals) for best absorption.

ii. Chew or swallow whole according to directions on the bottle. Sustained release form is the most popular oral form and must be chewed or crushed.

C. Buccal.

i. Allow to dissolve between cheek and gum.

ii. It should dissolve in three to five minutes.

D. Ointment.

i. Spread uniformly on nonhairy areas, except distal arms and legs or face and neck.

ii. Do not rub in.

4. General Education

A. Monitor blood pressure.

B. Replace supply every three to six months to ensure freshness.

C. Store sublingual tablets in original container, away from moisture or light. (Discard opened bottle after 3 months.)

D. Check expiration date of nitroglycerin.

E. Notify physician if headache is severe and lasts longer than fifteen to twenty minutes.

F. Report increased frequency of anginal attacks to physician.

G. Carry medication with you at all times.

H. Take nitroglycerin before beginning any activity that may precipitate and anginal attack, such as increased activity or stress.

I. Avoid alcoholic beverages, which may increase possibility of hypotension.

J. Change position slowly to prevent orthostatic hypotension.

K. Avoid over-the-counter medications without permission by physician due to possible interactions.