Medicine & USMLE

Nitroglycerin Administration

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Cardio Drugs - Other
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  10. Dobutamine
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  12. Atropine

Summary

Nitroglycerin is administered via several different routes. Each form of this medication should be protected from light.

Intravenous or IV nitroglycerin should be directly infused from a glass bottle using special tubing.

Nitroglycerin that comes as a sublingual tablet or translingual spray should not be swallowed, but instead be allowed to absorb into the oral mucosa. A mild burning sensation may be felt in the mouth, but this is a normal and expected side effect. Both the tablet and spray are used to treat acute chest pain and should be taken at the first indication of chest pain. The patient can take a maximum of three doses, waiting five minutes between each dose. If the chest pain does not go away after the first dose, the patient should call 911. Since both the tablet and spray have a short shelf-life, it’s important to always check the expiration date and replace the drug when necessary.

Nitroglycerin can also be absorbed through the skin via a transdermal patch or a topical ointment to treat chronic chest pain. When given in this way, the application site should be rotated to prevent skin irritation. Always wear gloves when handling a patient’s nitroglycerin patch or ointment. The patch is applied once a day and then removed at night, and remember to apply the patch to a hairless area of skin for optimal absorption.

Key Points

  • Nitroglycerin Administration
    • Protect from light
      • Store in original packaging
      • Store in a cool, dark place (i.e. not in a car or on a windowsill)
      • This is applicable to all administration routes
    • Sublingual Tablet / Translingual Spray
      • Short-acting, used for acute anginal attacks
      • Tablet is placed under tongue to dissolve
      • Spray is sprayed directly onto or under tongue
      • Do not swallow
        • The medication will not be effective if swallowed
      • Use at first indication of chest pain
      • May be taken every 5 minutes for a max of 3 doses
        • If patient is at home, call 911 if the first dose is unsuccessful at relieving the pain
        • If in the hospital, call the physician if pain is unresolved after 3 doses
      • Mild burning sensation in mouth is normal
        • The patient may or may not experience a tingling, burning, or stinging sensation in their mouth
        • This is an indicator that the tablet is fresh and working properly
        • Just because the patient doesn’t experience tingling, doesn’t mean the medication isn’t working
      • Check expiration date
        • Teach patient to check expiration date and replace every 3-6 months
        • Expired medication will not be effective in treating chest pain
    • Transdermal Patch / Topical Ointment
      • Long-acting, used for chronic stable angina
      • Rotate application site
        • Rotate between chest, back, and upper arm
      • Wear gloves
        • Avoid touching the patch or ointment with bare hands
      • Remove patch at night
        • Patient should have “nitrate-free” periods every day to prevent building up tolerance to the medication
      • Avoid hairy areas
        • Hair on the skin affects adhesion and absorption of the medication
        • If needed, hair can be trimmed before application (NOT shaved)
      • Do not cut the patch
      • Patches/ointment may be worn while showering
      • The doctor may order the ointment to be wrapped with clear plastic wrap to help absorption
    • Intravenous Solution
      • Use specific tubing
        • Nitroglycerin absorbs into polyvinyl chloride tubing, so it is recommended to use specialized polyethylene tubing.
        • This allows the whole dose to reach the bloodstream
      • Use glass bottle
        • Nitroglycerin absorbs and interacts with the plastic in typical IV bags, so it should be administered in a glass IV bottle