Never give with sildenafil or other PDE-5 inhibitors taken within 24-48 hours, severe hypotension can result.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client is prescribed intravenous nitroglycerin for unstable angina. Which assessment is MOST important for the nurse to monitor closely during the infusion?
Answer: B. Nitroglycerin is a potent vasodilator that lowers blood pressure; hypotension is the major dose-limiting effect, so blood pressure must be monitored frequently and the dose titrated accordingly. While headache and heart rate matter, the priority safety concern during titration is a drop in blood pressure that could reduce coronary and cerebral perfusion.
Question 2 of 5
A client receiving a continuous IV nitroglycerin infusion for an acute coronary event reports dizziness, and the blood pressure drops to 84/50. What is the priority nursing action?
Answer: A. Nitroglycerin causes vasodilation and can produce significant hypotension. The priority is to reduce or stop the infusion (titrate down per protocol) and reassess blood pressure, often placing the client supine and notifying the provider. Increasing the rate would worsen hypotension.
Question 3 of 5
A client is prescribed sublingual nitroglycerin for angina at home. Which statement by the client indicates a correct understanding of how to store and use the medication?
Answer: B. Nitroglycerin degrades with exposure to light, heat, and moisture, so it must be kept in its original dark glass container, tightly capped, and replaced about every 3 to 6 months. The client should sit or lie down when taking it because of the risk of orthostatic hypotension. Storing it in a daily pill organizer, in a humid bathroom, or keeping tablets for years all reduce potency.
Question 4 of 5
A client with chest pain is prescribed sublingual nitroglycerin. Before administering, which assessment is most important?
Answer: A. Nitroglycerin is a potent vasodilator that lowers blood pressure. Checking the blood pressure first is essential; it is withheld if systolic BP is below 90 mmHg or if a phosphodiesterase inhibitor was recently taken.
Question 5 of 5
A client is taking sublingual nitroglycerin and asks how to store the tablets. Which instruction by the nurse is correct?
Answer: A. Nitroglycerin tablets are sensitive to heat, light, and moisture, which degrade the drug. They should be kept in the original dark glass container with the lid tightly closed, stored at room temperature away from heat and light, and not carried in a warm pocket or stored in a humid bathroom. A fresh supply is needed periodically because potency declines. Plastic pill organizers and the bathroom medicine cabinet are inappropriate.
Keep the streak going with more questions like these, each with a full rationale.
What is nitroglycerin?
It dilates veins (reducing preload) and coronary arteries, lowering myocardial oxygen demand and relieving ischemic pain. Memory aid: nitrates dilate, so blood pressure deflates.
Key points to remember
- Sublingual dose: one tablet every 5 minutes for up to 3 doses; call EMS if pain unrelieved after the first dose (current AHA guidance).
- Causes vasodilation, so headache, flushing, hypotension, and reflex tachycardia are expected effects.
- Tablets are light- and heat-sensitive; stored in the original dark glass bottle and replaced every 3-6 months.
- Transdermal patches require a 10-14 hour nitrate-free interval daily to prevent tolerance.
- Contraindicated with phosphodiesterase-5 inhibitors (sildenafil, tadalafil, vardenafil) due to life-threatening hypotension.
- IV nitroglycerin must be given with non-PVC tubing because PVC absorbs the drug.
Nursing priorities
- Assess blood pressure before and after each dose; hold and notify provider if systolic below 90 mmHg.
- Have the patient sit or lie down before sublingual administration to prevent falls from hypotension.
- Remove an old transdermal patch before applying a new one and rotate sites, wearing gloves to avoid self-absorption.
- Continuously monitor blood pressure and titrate IV infusions per pain and pressure response.
Patient teaching
- Expect a transient throbbing headache and tingling under the tongue; this confirms potency, not allergy.
- Sit down and take one tablet; if pain persists after 5 minutes, call 911, then may repeat up to 3 doses total.
- Rise slowly from sitting or lying to prevent dizziness and falls (orthostatic hypotension).
- Keep tablets in the original amber glass bottle, away from light and heat, and replace as directed.
- Avoid alcohol and erectile dysfunction drugs, which intensify the blood-pressure-lowering effect.
Red flags: report now
- Never give with sildenafil or other PDE-5 inhibitors taken within 24-48 hours, severe hypotension can result.
- Report systolic BP below 90 mmHg, worsening or unrelieved chest pain, or syncope immediately.
- Reflex tachycardia or signs of right ventricular MI (preload-dependent) warrant holding nitrates and notifying the provider.
References
Clinical references for this topic
