while discussing the antianginal drugs, especially Nitrates I found there is a lot to tell you. Mainly, on the precautions that you must take while administering IV nitroglycerine. So I thought to write a separate post on the nursing considerations. I believe this would be useful for you throughout your nursing career and while preparing for any international nursing licence exams.
I arranged the points under two headings. First, points to remember on administering all preparations other than IV and Second, points to remember on administering IV Nitroglycerine.
ADMINISTRATION OF NITRATES
Oral Sustained-Release Tablets of NTG should be taken on an empty stomach with full glass of water
Carry S/L tablets in the glass bottle, tightly capped. Nitroglycerin can lose potency if exposed to light, moisture, or heat. Also to discard the tablets and get a new supply every 8 weeks. Now, NTG sprays are prefered over the tablets due to the longer shelf life when compared to its S/L form.
If the chest pain is not relieved by 1 S/L tab, give 2 more tabs with a 5-minute interval. even after the third tablet (within 15 minutes), the pain persists, shift the client to the emergency department as the chest pain can be an MI and not Angina. your chest pain… is it simply a chest pain or a heart attack???
S/L tabs or sprays to be taken in sitting position to avoid postural hypotension
Explain that slight stinging, burning, or tingling under the tongue indicates the potency of the drug. Get a new supply if these sensations are not present.
Avoid alcohol, hot baths, saunas, and whirlpools, as they can cause vasodilatation and lead to hypotension and fainting.
To minimise the tolerance to NTG the patches are removed after 12 hours. And a 12-hour gap is given before the next patch
- Instruct client to not take sildenafil (Viagra) within 24 hours after taking
nitrates, and wait 24 hours after taking Viagra to resume nitrate therapy
IV ADMINISTRATION OF NITRATES
Use glass containers and tubings or PVC tubings to administer IV GTN. (other materials absorb it and reduce potency)
Administer using an infusion pump that can maintain constant infusion rate
Strictly maintain BP CHART. Monitor the BP every 5 -15 minutes
Remove topical forms when starting IV infusion
- Administer nitroglycerine diluted in 5% dextrose. Do not mix it with any other drugs
- Nitrates can develop a tolerance to the drug. May need 10-12 hr/day nitrate-free interval to avoid tolerance development
- Sudden cessation of the therapy may cause withdrawal reactions. Gradually reduce the dose and withdraw the therapy.
- Intravenous Drip: Begin at 5 mcg/min and titrate every 3-5 minutes to therapeutic response and stable vital signs. Titrate NTG infusion until relief of chest pain or a maximum of 200 mcg/min dose is achieved.