Pharmacological and Parenteral Therapies Q 13
The client admitted with angina is given a prescription for nitroglycerin. The client should be instructed to:
A. Replenish his supply every 3 months
B. Take one every 15 minutes if pain occurs
C. Leave the medication in the brown bottle
D. Crush the medication and take with water
Correct Answer: C. Leave the medication in the brown bottle
Nitroglycerine should be kept in a brown bottle (or even a special air- and water-tight, solid or plated silver or gold container) because of its instability and tendency to become less potent when exposed to air, light, or water. Store nitroglycerin pills in a dark-colored (such as brown), airtight, glass container that you cannot see through. Keep the container tightly closed. Keep nitroglycerin pills and liquid spray away from heat or moisture.
Option A: The supply should be replenished every 6 months, not 3 months. Nitroglycerin is most commonly administered as a tablet that is absorbed sublingually. It is given in hospitals as well as prescribed for outpatient use. Patients may be prescribed nitroglycerin to take as prophylaxis for anginal chest pain prior to an event that may provoke anginal symptoms. They must be instructed to allow the nitroglycerin to dissolve in their mouth and allow their oral mucosa to absorb the drug.
Option B: One tablet should be taken every 5 minutes until pain subsides. If the pain does not subside, the client should report to the emergency room. There currently are three doses available: 0.3 mg, 0.4 mg, and 0.6 mg. The dose is repeatable every 5 minutes until the achievement of relief. If anginal pain persists after three doses, prompt medical attention is required. After administration, the onset of vasodilatory effects occurs within 1 to 3 minutes, with a max effect occurring within 5 minutes.
Option D: The medication should be taken sublingually and should not be crushed. Nitroglycerin is primarily eliminated via metabolism in the liver and has a mean half-life of approximately 2 to 3 minutes. In the event of overdose, monitoring of vital signs may be necessary to monitor the hemodynamic effects of nitroglycerin. Continuous monitoring of blood pressure, heart rate, respiratory rate, and oxygen saturation is recommended.