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Glyceryl trinitrate

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VOL: 102, ISSUE: 04, PAGE NO: 31

GENERIC AND PROPRIETARY NAMES

- Glyceryl trinitrate/Coro-Nitro Pump Spray; Glytrin Spray; GTN 300mcg; Nitrolingual Pumpspray; Nitromin; Suscard; Sustac; Nitrocine; Nitronal; Deponit; Minitran; Nitro-Dur; Percutol; Transiderm-Nitro; Trintek.

CLASSIFICATION

- Nitrates.

ACTION

- A potent coronary vasodilator that reduces venous return and therefore left ventricular work.

INDICATIONS

- Treatment and prophylaxis of angina.

- Left ventricular failure.

CONTRAINDICATIONS

- Marked anaemia.

- Hypotensive conditions.

- Hypovolaemia.

- Hypersensitivity to nitrates.

- Mitral stenosis.

- Aortic stenosis.

- Hypertrophic obstructive cardiomyopathy.

- Cardiac tamponade.

- Constrictive pericarditis.

- Closed angle glaucoma.

CAUTIONS

- Severe hepatic or renal impairment.

- Hypothyroidism.

- Recent history of myocardial infarction.

- Hypothermia.

- Trauma to the head.

- Malnutrition.

- Cerebral haemorrhage.

SIDE-EFFECTS

- Severe headache.

- Dizziness.

- Flushing.

- Postural hypotension.

- Tachycardia.

- Some instances of paradoxical bradycardia have been reported.

INTERACTIONS

- Antihypertensive medication.

- Beta-blockers.

- Diuretics.

- Anticoagulants.

- Sildenafil (Viagra).

ADMINISTRATION

- Sublingually.

- Aerosol spray.

- Modified-release tablets.

- Buccal tablets.

- Transdermal preparation.

- Intravenous injection.

NURSING CONSIDERATIONS

- Patients on long-acting or transdermal preparations commonly develop tolerance and reduced therapeutic effects.

- Evaluate therapeutic response.

- Metal-containing transdermal systems should be removed before cardioversion or diathermy.

- Periodic blood pressure checks are necessary.

- Most side-effects will reduce over time.

PATIENT TEACHING

- Ensure patients understand that they should not stop taking this medication without seeking medical advice.

- Sublingual tablets must be stored in a tightly closed glass container in a cool dry place and used within eight weeks.

- For treatment of angina this medication should be used at the onset of an attack.

- Nitrates should be taken while seated because a drop in blood pressure can result in fainting.

- Avoid excessive alcohol intake.

- Ensure that patients are aware that this medication may cause headache and that simple analgesics can be used to relieve this.

Nurses should refer to manufacturer’s summary of product characteristics and to appropriate local guidelines

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