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Chapter 23: Anti-anginal drugs test, Patient, Nitroglycerin Sublingual Tablets, Tylenol

The key terms in this Pharmacology course include Anti-anginal drugs Test, Patient, Nitroglycerin Sublingual Tablets, Tylenol, Nurse, Noncardioselective Beta Blocker, Bronchial Asthma, Prescription, Medication, Discharge, Longest Duration of Action, Nitroglycerin Transdermal Patch, Nitroglycerin Ointment

Which statement by the patient demonstrates a need for further education regarding nitroglycerin sublingual tablets?

“If I get a headache, I should keep taking my nitroglycerin and use Tylenol to relieve my headache.

“I can take up to four tablets at 5-minute intervals for chest pain.”

“I should change positions slowly to avoid getting dizzy from the drug’s effect on my blood pressure.”

“I should keep my nitroglycerin in a cool, dry place.”

Patients are taught to take up to three sublingual tablets 5 minutes apart. According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes, after one dose, the patient (or family member) must call 911 immediately. The patient can take one more tablet while awaiting emergency care and a third tablet 5 minutes later, but no more than three tablets total. Patients should always sit or lie down before taking this medication.

When caring for a patient with angina pectoris, the nurse would question a prescription for a noncardioselective beta blocker in a patient with which pre-existing condition?


Bronchial asthma

Myocardial infarction

Atrial fibrillation

Noncardioselective beta blockers should be used with caution in patients with bronchial asthma, because any level of blockade of beta2 receptors can promote bronchoconstriction.

The nurse is providing discharge teaching for a patient with a new prescription for nitroglycerin sublingual tablets. Which statement by the patient indicates an understanding of the nurse’s discharge instructions about this medication?

“I will keep my nitroglycerin tablets in their original glass container.”

“My nitroglycerin tablets are not affected by cold or heat.”

“I will need to refill my prescription when I feel burning under my tongue.”

“I can take some aspirin if I get a headache related to nitroglycerin.”

The sublingual dosage form of nitroglycerin needs to be kept in its original amber-colored glass container with metal lid to avoid loss of potency from exposure to heat, light, moisture, and cotton filler. It should be replaced every 3 to 6 months in order to maintain potency. Potency of the sublingual nitroglycerin is noted if there is burning or stinging when the medication is placed under the tongue; if the medication does not burn, then the drug has lost its potency, and a new prescription must be obtained. Headaches associated with nitrates last approximately 20 minutes (with sublingual forms) and may be managed with acetaminophen.

Which method of administration of nitroglycerin has the longest duration of action?

Sublingual tablet

Immediate-release tablet

Transdermal patch

Intravenous (IV) infusion

The transdermal patch has an 8- to 12-hour duration of action compared with 3 minutes to 6 hours for the other methods of administration of nitroglycerin.

To prevent the development of tolerance to nitroglycerin transdermal patch, the nurse instructs the patient to perform which action?

Apply the nitroglycerin patch in the morning and remove it at night for 8 hours.

Apply a new nitroglycerin patch every other day.

Use the nitroglycerin patch for acute episodes of angina only.

Switch to sublingual nitroglycerin when the systolic blood pressure is greater than 140 mm Hg.

To avoid development of tolerance to transdermal nitroglycerin patches, maintain an 8-hour nitrate-free period each day. A common regimen with transdermal patches is to remove them at night for 8 hours and apply a new patch in the morning.

When applying nitroglycerin ointment, the nurse would perform which action?

Apply a thick layer of ointment on the nitroglycerin paper.

Massage and then gently rub the ointment into the skin.

Apply the ointment to a nonhairy part of the upper torso.

Use the fingers to spread the ointment evenly over a 3-inch area.

Use the proper dosing paper supplied by the drug company to apply a thin layer of ointment on clean, dry, hairless skin of the upper arms or body. Avoid areas below the knees and elbows. Wear gloves to avoid contact with the skin and subsequent absorption. Do not rub the ointment into the skin; cover the area with an occlusive dressing if not provided (e.g., plastic wrap).