NR293 PHARMACOLOGY FINAL EXAM STUDY GUIDE - PART 1 2023/2024

NITROGLYCERIN - THERAPEUTIC/PHARMACOLOGIC CLASS - ANSWER-antianginal agent/nitrate NITROGLYCERIN - MECHANISM OF ACTION - ANSWER-dilates the blood vessels decreases preload reduces myocardial oxygen consumption NITROGLYCERIN - INDICATIONS - ANSWER-Treatment and prophylaxis of angina pectoris *Rapid-Acting* treat angina attacks *Long-Acting* prevent angina attacks from occuring *IV Form* for severe unstable angina attacks control BP perioperatively treat heart failure after acute MI NITROGLYCERIN - ADMINISTRATION OF SUBLINGUAL TABLETS - ANSWER-Patient needs to sit or lie down Place sublingual tablet under tongue to dissolve when chest pain starts if not relieved in 5 minutes, call 911, take a second tablet take a third tablet 5 minutes later if no relief *MAX DOSE* 3 tablets within 15 minute period NITROGLYCERIN - FORMS - ANSWER-sublingual tablets sustained-release capsules or tablets (*do not chew/crush*) a translingual spray transmucosal tablets transdermal ointment transdermal patch IV form NITROGLYCERIN - ADMINISTRATION OF IV FORM - ANSWER-Non-polyvinylchloride (non-PVC) plastic intravenous bags and tubing must be used given via an infusion pump no other medications may be given if parenteral solution is discolored blue or green, it should be discarded NITROGLYCERIN - ADVERSE EFFECTS - ANSWER-headache flushing of the face dizziness syncope/fainting tachycardia hypotension NITROGLYCERIN - CONTRAINDICATIONS - ANSWER-known drug allergy severe anemia closed-angle glaucoma *hypotension* severe head injury erectile dysfunction drugs - sildenafil (Viagra) - tadalafil (Cialis) - vardenafil (Levitra) NITROGLYCERIN - PRECAUTIONS - ANSWER-hypotension hypovolemia hyperthyroidism liver disease conditions that cause dry mouth early MI older adults NITROGLYCERIN - INTERACTIONS - ANSWER-Increased hypotension may result when used with other antihypertensive drugs or with alcohol PDE5 inhibitors, such as sildenafil (Viagra) may cause severe hypotension Beta blockers and calcium channel blockers decrease tachycardia caused by nitroglycerin SUBLINGUAL NITROGLYCERINE STORAGE - PATIENT TEACHING - ANSWER-keep medication in its original container away from heat and light NITROGLYCERIN TOLERANCE - PATIENT TEACHING - ANSWER-To avoid development of tolerance to transdermal nitroglycerin patches, maintain an 8-hour nitrate-free period each day remove patch at night for 8 hours and apply a new patch in the morning NITROGLYCERIN OINTMENT - PATIENT TEACHING - ANSWER-use dosing paper supplied by the drug company apply a *thin layer* of ointment on clean, dry, hairless skin of the upper arms or torso. Avoid areas below the knees and elbows. Wear gloves to avoid contact with the skin (and subsequent absorption) *Do not rub the ointment into the skin*