{"id":276,"date":"2019-12-08T22:18:59","date_gmt":"2019-12-08T22:18:59","guid":{"rendered":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/chapter\/6-8-antianginal-nitrates\/"},"modified":"2025-01-16T22:27:15","modified_gmt":"2025-01-16T22:27:15","slug":"6-8-antianginal-nitrates","status":"publish","type":"chapter","link":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/chapter\/6-8-antianginal-nitrates\/","title":{"raw":"6.8 Antianginal – Nitrates","rendered":"6.8 Antianginal – Nitrates"},"content":{"raw":"Antianginal medication is used to treat angina pectoris. Angina is chest pain caused by inadequate blood flow, resulting in hypoxia of the cardiac tissue. Angina can be chronic pain caused by atherosclerosis in coronary artery disease or acute pain caused by a myocardial infarction.\n\nAntianginals increase blood flow to the heart or decrease oxygen demand by the heart. Nitrates promote vasodilation of coronary arteries and veins. Beta-blockers and calcium channel blockers are also used to decrease workload of the heart and decrease oxygen demands.\n\nNitrates may come in a variety of routes, such as sublingual, extended-release tablets, creams, transdermal patches, and intravenously. The grid below focuses on administration via sublingual tablets. Sublingual tablets are prescribed PRN (\u201cas needed\u201d) for client<\/span>s who are experiencing chronic, stable angina due to coronary artery disease.\n\nMechanism of Action: <\/strong>Nitroglycerin relieves angina by relaxing vascular smooth muscle, resulting in vasodilation.\n\nIndications: <\/strong>Nitroglycerin is used to relieve angina due to coronary artery disease, during times of an acute attack, or prophylactically.\n\nNursing Considerations: <\/strong>Client<\/span>s taking sildenafil (Viagra) or similar medications for erectile dysfunction in the previous 24 hours may not take nitroglycerin as this may result in a dangerous drop in blood pressure.\n\nNitroglycerin should not be used in pregnant women or those who are breastfeeding.\n\nNitroglycerin is contraindicated in client<\/span>s who have severe anemia, increased intracranial pressure, hypersensitivity, or circulatory failure.\n\nSide Effects\/Adverse Effects: <\/strong>Client<\/span>s taking nitroglycerin may experience hypotension, palpitations, headache, weakness, sweating, flushing, nausea, vomiting, or dizziness.\n\nHealth Teaching & Health Promotion: <\/strong>Client<\/span>s should allow medication to dissolve under their tongue. This route allows immediate absorption into the circulation and avoids first-pass metabolism by the liver. Clients<\/span> may take up to one tablet every 5 minutes or up to three sublingual tablets within 15 minutes to relieve chest pain. If chest pain is not relieved after the first dose, 911 should be called. Nitroglycerin may also be used prophylactically 5 to 10 minutes prior to engaging in activities that might precipitate an acute attack.\n\nInstruct client<\/span>s to avoid eating or smoking during administration as this may alter absorption. Client<\/span>s should sit during administration to decrease the risk for injury due to the possibility of hypotension, dizziness, and weakness. Nitroglycerin decomposes when exposed to heat or light, so it should be stored in the original, airtight glass container. See Figure 6.23[footnote]\u201cNitroglycerin (1).JPG<\/a>\u201d by Intropin<\/a> is licensed under CC BY 3.0<\/a>[\/footnote]<\/sup> for an image of nitroglycerin containers.[footnote]This work is a derivative of DailyMed<\/a> by U.S. National Library of Medicine<\/a> in the Public Domain<\/a>. [\/footnote]<\/sup>\n\nHistorically, client<\/span>s have been taught to seek emergency help (call 911) if pain persists after the third dose of medication. However, new guidelines from the American Heart Association urge client<\/span>s to call 911 after the first dose if symptoms are not improved or become worse.[footnote]O\u2019Gara, P., Kushner, F., Ascheim, D., Casey, D., Chung, M., de Lemos, J., Ettinger, S., Fang, J., Fesmire, F., Franklin, B., Granger, C., Krumholz, H., Linderbaum, J., Morrow, D., Newby, L., Ornato, J., Ou, N., Radford, M., Tamis-Holland, J., Tommaso, C., Tracy, C., Woo, Y., & Zhao, D. (2013).\u00a0 ACCF\/AHA guideline for the management of ST-elevation myocardial infarction: A report of the American College of Cardiology Foundation\/American Heart Association task force on practice guidelines. Circulation, 127<\/em>(4). https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIR.0b013e3182742cf6?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed<\/a> [\/footnote]<\/sup>\n\n[caption id=\"\" align=\"aligncenter\" width=\"232\"]\"Photo Figure 6.23 Sublingual Nitroglycerin Stored in Original, Airtight Glass Container[\/caption]\n\nNow let's take a closer look at the medication grid for nitroglycerin in Table 6.8.[footnote]This work is a derivative of\u00a0DailyMed<\/a>\u00a0by\u00a0U.S. National Library of Medicine<\/a> in the\u00a0Public Domain<\/a>. [\/footnote]<\/span><\/sup>\n\nTable 6.8 Nitroglycerine Medication Grid\n\n\n\n\n
Class\/<\/strong>Subclass<\/strong><\/th>\nPrototype\/G<\/strong>eneric<\/strong><\/th>\nNursing <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nSide\/Adverse Effects<\/strong><\/th>\n<\/tr>\n
Nitrate<\/strong><\/td>\nnitroglycerin<\/a><\/td>\nClient<\/span>s may take up to three sublingual tablets within 15 minutes (one every 5 minutes) to relieve chest pain\n\nIf symptoms are not improved after the first dose or become worse or if the pain persists after the third dose of medication, seek emergency help (call 911).\u00a0 Nurses should check BP after each dose\n\nNo eating or smoking during administration of SL tablet\n\nDo not chew or crush SL tablet\n\nAdvise client<\/span>s to sit while taking this medication\n\nPaste\/Transdermal: Apply the paste or transdermal patch to a clean, dry area of skin on the upper body or arm. Rotate application sites to prevent skin irritation. Follow the medication instructions for how often to apply the paste or patch<\/td>\nDecrease chest pain<\/td>\nHypotension and palpitations\n\nHeadache, weakness, sweating, flushing, nausea, vomiting, and dizziness<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
\n
\n

Critical Thinking Activity 6.8\"Image<\/h2>\n<\/header>\n
\n\nA client<\/span> was administered the first dose of nitroglycerin at 1305 for acute angina. What should the nurse evaluate after administration?\n\nNote: Answers to the Critical Thinking activities can be found in the \"Answer Key<\/a>\" section at the end of the book.\n\n<\/div>\n<\/div>\n<\/div>","rendered":"

Antianginal medication is used to treat angina pectoris. Angina is chest pain caused by inadequate blood flow, resulting in hypoxia of the cardiac tissue. Angina can be chronic pain caused by atherosclerosis in coronary artery disease or acute pain caused by a myocardial infarction.<\/p>\n

Antianginals increase blood flow to the heart or decrease oxygen demand by the heart. Nitrates promote vasodilation of coronary arteries and veins. Beta-blockers and calcium channel blockers are also used to decrease workload of the heart and decrease oxygen demands.<\/p>\n

Nitrates may come in a variety of routes, such as sublingual, extended-release tablets, creams, transdermal patches, and intravenously. The grid below focuses on administration via sublingual tablets. Sublingual tablets are prescribed PRN (\u201cas needed\u201d) for client<\/span>s who are experiencing chronic, stable angina due to coronary artery disease.<\/p>\n

Mechanism of Action: <\/strong>Nitroglycerin relieves angina by relaxing vascular smooth muscle, resulting in vasodilation.<\/p>\n

Indications: <\/strong>Nitroglycerin is used to relieve angina due to coronary artery disease, during times of an acute attack, or prophylactically.<\/p>\n

Nursing Considerations: <\/strong>Client<\/span>s taking sildenafil (Viagra) or similar medications for erectile dysfunction in the previous 24 hours may not take nitroglycerin as this may result in a dangerous drop in blood pressure.<\/p>\n

Nitroglycerin should not be used in pregnant women or those who are breastfeeding.<\/p>\n

Nitroglycerin is contraindicated in client<\/span>s who have severe anemia, increased intracranial pressure, hypersensitivity, or circulatory failure.<\/p>\n

Side Effects\/Adverse Effects: <\/strong>Client<\/span>s taking nitroglycerin may experience hypotension, palpitations, headache, weakness, sweating, flushing, nausea, vomiting, or dizziness.<\/p>\n

Health Teaching & Health Promotion: <\/strong>Client<\/span>s should allow medication to dissolve under their tongue. This route allows immediate absorption into the circulation and avoids first-pass metabolism by the liver. Clients<\/span> may take up to one tablet every 5 minutes or up to three sublingual tablets within 15 minutes to relieve chest pain. If chest pain is not relieved after the first dose, 911 should be called. Nitroglycerin may also be used prophylactically 5 to 10 minutes prior to engaging in activities that might precipitate an acute attack.<\/p>\n

Instruct client<\/span>s to avoid eating or smoking during administration as this may alter absorption. Client<\/span>s should sit during administration to decrease the risk for injury due to the possibility of hypotension, dizziness, and weakness. Nitroglycerin decomposes when exposed to heat or light, so it should be stored in the original, airtight glass container. See Figure 6.23[1]<\/sup><\/a><\/sup> for an image of nitroglycerin containers.[2]<\/sup><\/a><\/sup><\/p>\n

Historically, client<\/span>s have been taught to seek emergency help (call 911) if pain persists after the third dose of medication. However, new guidelines from the American Heart Association urge client<\/span>s to call 911 after the first dose if symptoms are not improved or become worse.[3]<\/sup><\/a><\/sup><\/p>\n

\"Photo
Figure 6.23 Sublingual Nitroglycerin Stored in Original, Airtight Glass Container<\/figcaption><\/figure>\n

Now let’s take a closer look at the medication grid for nitroglycerin in Table 6.8.[4]<\/sup><\/a><\/span><\/sup><\/p>\n

Table 6.8 Nitroglycerine Medication Grid<\/p>\n\n\n\n\n
Class\/<\/strong>Subclass<\/strong><\/th>\nPrototype\/G<\/strong>eneric<\/strong><\/th>\nNursing <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nSide\/Adverse Effects<\/strong><\/th>\n<\/tr>\n
Nitrate<\/strong><\/td>\nnitroglycerin<\/a><\/td>\nClient<\/span>s may take up to three sublingual tablets within 15 minutes (one every 5 minutes) to relieve chest pain<\/p>\n

If symptoms are not improved after the first dose or become worse or if the pain persists after the third dose of medication, seek emergency help (call 911).\u00a0 Nurses should check BP after each dose<\/p>\n

No eating or smoking during administration of SL tablet<\/p>\n

Do not chew or crush SL tablet<\/p>\n

Advise client<\/span>s to sit while taking this medication<\/p>\n

Paste\/Transdermal: Apply the paste or transdermal patch to a clean, dry area of skin on the upper body or arm. Rotate application sites to prevent skin irritation. Follow the medication instructions for how often to apply the paste or patch<\/td>\n

Decrease chest pain<\/td>\nHypotension and palpitations<\/p>\n

Headache, weakness, sweating, flushing, nausea, vomiting, and dizziness<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\n
\n
\n

Critical Thinking Activity 6.8\"Image<\/h2>\n<\/header>\n
\n

A client<\/span> was administered the first dose of nitroglycerin at 1305 for acute angina. What should the nurse evaluate after administration?<\/p>\n

Note: Answers to the Critical Thinking activities can be found in the “Answer Key<\/a>” section at the end of the book.<\/p>\n<\/div>\n<\/div>\n<\/div>\n

  1. \u201cNitroglycerin (1).JPG<\/a>\u201d by Intropin<\/a> is licensed under CC BY 3.0<\/a> ↵<\/a><\/li>
  2. This work is a derivative of DailyMed<\/a> by U.S. National Library of Medicine<\/a> in the Public Domain<\/a>. ↵<\/a><\/li>
  3. O\u2019Gara, P., Kushner, F., Ascheim, D., Casey, D., Chung, M., de Lemos, J., Ettinger, S., Fang, J., Fesmire, F., Franklin, B., Granger, C., Krumholz, H., Linderbaum, J., Morrow, D., Newby, L., Ornato, J., Ou, N., Radford, M., Tamis-Holland, J., Tommaso, C., Tracy, C., Woo, Y., & Zhao, D. (2013).\u00a0 ACCF\/AHA guideline for the management of ST-elevation myocardial infarction: A report of the American College of Cardiology Foundation\/American Heart Association task force on practice guidelines. Circulation, 127<\/em>(4). https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIR.0b013e3182742cf6?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed<\/a> ↵<\/a><\/li>
  4. This work is a derivative of\u00a0DailyMed<\/a>\u00a0by\u00a0U.S. National Library of Medicine<\/a> in the\u00a0Public Domain<\/a>. ↵<\/a><\/li><\/ol><\/div>","protected":false},"author":83,"menu_order":8,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[48],"contributor":[],"license":[],"class_list":["post-276","chapter","type-chapter","status-publish","hentry","chapter-type-numberless"],"part":238,"_links":{"self":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/276","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/wp\/v2\/users\/83"}],"version-history":[{"count":1,"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/276\/revisions"}],"predecessor-version":[{"id":277,"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/276\/revisions\/277"}],"part":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/parts\/238"}],"metadata":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/276\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/wp\/v2\/media?parent=276"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/chapter-type?post=276"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/wp\/v2\/contributor?post=276"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/wp\/v2\/license?post=276"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}