Nitroglycerin

Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.

Nitroglycerin (brand names Nitrostat, Nitro-Dur) — Antianginal, vasodilator; Organic nitrate.

Identification

• Therapeutic class: Antianginal, vasodilator.
• Pharmacologic class: Organic nitrate.

Pharmacology

• Mechanism of action: Rapid nitric oxide release dilates veins and coronary arteries, relieving acute angina.
• Onset / peak / duration: Sublingual onset 1 to 3 minutes; IV immediate; patch over hours.
• Half-life / therapeutic level: Half-life 1 to 4 minutes; no routine level.

Clinical use

• Indications: Acute angina (sublingual), acute coronary syndrome and hypertensive emergencies (IV), angina prevention (patch).
• Usual dose, route, frequency: SL 0.3 to 0.6 mg every 5 minutes up to 3 doses; IV titrated; patch on for 12 to 14 hours then off.
• Maximum dose / adjustments: SL maximum 3 doses in 15 minutes; call emergency services if pain persists; patch requires a nitrate-free interval.

Safety

• Contraindications: PDE-5 inhibitor use, severe hypotension, right ventricular MI, increased intracranial pressure.
• Black box warning: None.
• Interactions: PDE-5 inhibitors (severe hypotension), antihypertensives, alcohol.
• Pregnancy / lactation: Use only if clearly needed.
• High-alert: IV nitroglycerin warrants extra caution.

Adverse effects

• Common side effects: Headache, dizziness, flushing, hypotension.
• Serious effects to report: Severe hypotension, reflex tachycardia, syncope.
• Antidote / reversal: Supportive care; fluids and positioning for hypotension.

Nursing process

• Assessment before administration: Blood pressure, chest pain characteristics, PDE-5 inhibitor use.
• Interventions during therapy: Have patient sit or lie down for sublingual dosing; remove old patch before applying new one.
• Monitor: Blood pressure, pain relief, heart rate.
• Evaluation / expected outcome: Relief of acute chest pain.

Patient teaching

• Patient teaching: Sit down before taking sublingual; if pain persists after one dose, call emergency services; store tablets in the original dark glass bottle.
• Notify provider if: Chest pain not relieved, fainting.
• Administration tips: SL under the tongue, do not swallow; rotate and time patches; never combine with erectile dysfunction drugs.