![]() ![]() This triggers pain receptors within the heart, which leads to the classical presentation of chest pain and the sensation of substernal heaviness or pressure.Īs described below and in the above figure, decreased oxygen delivery can be caused by either reduced coronary blood flow or reduced coronary blood oxygen content. When coronary blood flow cannot deliver sufficient oxygen to support cardiac oxidative metabolism (reduced oxygen supply/demand ratio), the myocardium becomes hypoxic. If symptoms are not improved after the first dose or become worse, or if the pain persists after the 3rd dose of medication, seek emergency help (call 911).Angina, which is sometimes called angina pectoris, is chest pain or discomfort that is caused by inadequate coronary blood flow (i.e., ischemia) to meet the oxygen requirements of the myocardium. Patients may take up to 3 sublingual tablets within 15 minutes (1 every 5 minutes) to relieve chest pain Table 6.8 Nitroglycerine Medication Grid Class/ ![]() Now let’s take a closer look at the medication grid for nitroglycerin in Table 6.8. Figure 6.24 Sublingual nitroglycerin should be stored in its original, air tight glass container However, new guidelines from the American Heart Association urge patients to call 911 after the first dose if symptoms are not improved or become worse. Historically, patients have been taught to seek emergency help (call 911) if pain persists after the 3rd dose of medication. See Figure 6.24 for an image of nitroglycerin containers. Nitroglycerin decomposes when exposed to heat or light, so it should be stored in the original, airtight glass container. Patients should sit during administration to decrease the risk for injury due to the possibility of hypotension, dizziness, and weakness. Instruct patients to avoid eating or smoking during administration as this may alter absorption. Nitroglycerin may also be used prophylactically 5 to 10 minutes prior to engaging in activities that might precipitate an acute attack. If chest pain is not relieved after the first dose, 911 should be called. Patients may take up to one tablet every 5 minutes, up to 3 sublingual tablets within 15 minutes to relieve chest pain. This route allows immediate absorption into the circulation and avoids first-pass metabolism by the liver. Patients should allow medication to dissolve under their tongue. Patients taking nitroglycerin may experience hypotension, palpitations, headache, weakness, sweating, flushing, nausea, vomiting, or dizziness. Nitroglycerin is contraindicated in patients who have severe anemia, increased intracranial pressure, hypersensitivity, or circulatory failure. Nitroglycerin should not be used in pregnant women or those who are breastfeeding. Patients taking sildenafil (Viagra) or similiar medications for erectile dysfunction in the previous 24 hours may not take nitroglycerin as this may result in a dangerous drop in blood pressure. Nursing Considerations Across the Lifespan Nitroglycerin is used to relieve angina due to coronary artery disease, during times of an acute attack, or prophylactically. Nitroglycerin relieves angina by relaxing vascular smooth muscle, resulting in vasodilation. Sublingual tablets are prescribed PRN (“as needed”) for patients who are experiencing chronic, stable angina due to coronary artery disease. The grid below focuses on administration via sublingual tablets. Nitrates may come in a variety of routes, such as sublingual, extended-release tablets, creams, transdermal patches, and intravenously. Beta blockers and calcium channel blockers are also used to decrease workload of the heart and decrease oxygen demands. Nitrates promote vasodilation of coronary arteries and veins. Angina can be chronic pain caused by atherosclerosis in coronary artery disease or acute pain caused by a myocardial infarction.Īntianginals increase blood flow to the heart or decrease oxygen demand by the heart. Angina is chest pain caused by inadequate blood flow, resulting in hypoxia of the cardiac tissue. Antianginal medication is used to treat angina pectoris.
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