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INTRODUCTION

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nitroglycerin (nye-troe-glis-er-in)

extended-release capsules

Nitro-Time, Image not available.Nitrogard SR

intravenous

Nitro-Bid IV, Tridil

translingual spray

Nitrolingual, Nitromist

ointment

Nitro-Bid

sublingual

Nitrostat, NitroQuick

transdermal system

Minitran, Nitrek, Nitro-Dur

Classification

Therapeutic: antianginals

Pharmacologic: nitrates

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Indications
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Acute (translingual and SL) and long-term prophylactic (oral, transdermal) management of angina pectoris. PO: Adjunct treatment of CHF. IV: Adjunct treatment of acute MI. Production of controlled hypotension during surgical procedures. Treatment of CHF associated with acute MI.

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Action
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Increases coronary blood flow by dilating coronary arteries and improving collateral flow to ischemic regions. Produces vasodilation (venous greater than arterial). Decreases left ventricular end-diastolic pressure and left ventricular end-diastolic volume (preload). Reduces myocardial oxygen consumption. Therapeutic Effects: Relief or prevention of anginal attacks. Increased cardiac output. Reduction of blood pressure.

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Adverse Reactions/Side Effects
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CNS: dizziness, headache, apprehension, restlessness, weakness. EENT: blurred vision. CV: hypotension, tachycardia, syncope. GI: abdominal pain, nausea, vomiting. Derm: contact dermatitis (transdermal or ointment). Misc: alcohol intoxication (large IV doses only), cross-tolerance, flushing, tolerance.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Assess episodes of angina pectoris at rest and during exercise. Document whether drug therapy is helpful in reducing the frequency and severity of angina attacks.

  • Assess signs and symptoms of CHF (dyspnea, rales/crackles, peripheral edema, jugular venous distention, exercise intolerance) to help document whether drug therapy is effective in reducing these symptoms.

  • Assess dizziness and syncope that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

  • Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness, fainting, or other symptoms.

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report fast heart rate (tachycardia) or symptoms of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

  • If administered by a patch or ointment, monitor application site for redness and irritation. Report prolonged or excessive skin reactions to the physician or nursing staff.

  • Report signs of drug tolerance during long-term use, as indicated by increased episodes of angina or CHF symptoms. This problem may be resolved by instituting nitrate-free periods; that is, the physician may recommend removing the nitroglycerin patch for several hours each day.

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Interventions
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  • Design and implement aerobic exercise and endurance training programs to improve coronary perfusion, reduce angina, and improve myocardial pumping ability.

  • Because of an increased risk of angina, arrhythmias, or in conditions such as CHF or recent MI, use caution during aerobic exercise and endurance conditioning. Terminate exercise if patient exhibits untoward symptoms (chest pain, shortness of breath, ...

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