- Body system
- Cardiovascular
- Drug cards
- 1 in this guide
Drugs in this class
Other examples: Isosorbide mononitrate, Isosorbide dinitrate.
How nitrates work
Release nitric oxide, which relaxes vascular smooth muscle: venous dilation lowers preload, and coronary dilation improves blood flow to the heart muscle.
Uses
- Acute angina (sublingual nitroglycerin)
- Angina prevention (isosorbide, patches, ointment)
- Acute coronary syndrome and acute heart failure (IV nitroglycerin)
Adverse effects
- Headache
- Hypotension and dizziness
- Flushing
- Reflex tachycardia
- Tolerance with continuous use
Nursing considerations
- Check blood pressure before and after doses.
- Contraindicated within 24 hours of sildenafil or vardenafil and 48 hours of tadalafil.
- Keep a nitrate-free period (often overnight) with long-acting forms to prevent tolerance.
Patient teaching
- Sublingual nitroglycerin: sit down, take 1 tablet, and call 911 if the pain is not better or is worse 5 minutes after the first dose.
- Keep tablets in the original dark glass bottle.
- Acetaminophen can be used for nitrate headaches if your provider agrees.
Nitrates NCLEX practice questions
Answer each question to see the rationale.
3 questions. Choose an answer to see the rationale.
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A patient using sublingual nitroglycerin still has chest pain 5 minutes after the first tablet. What should the patient do?
Show answer
Answer B: Call 911 Current guidance is to call 911 if chest pain is unimproved or worse 5 minutes after the first dose, then continue as directed by EMS.
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Which drug taken in the past 24 hours is a contraindication to nitroglycerin?
Show answer
Answer C: Sildenafil Phosphodiesterase-5 inhibitors combined with nitrates can cause severe, life-threatening hypotension.
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Why is a nitroglycerin patch removed for 10 to 12 hours each day?
Show answer
Answer C: To prevent nitrate tolerance Continuous nitrate exposure leads to tolerance; a daily nitrate-free interval keeps the drug effective.
Frequently asked questions
What are nitrates?
Nitrates relieve and prevent angina by dilating veins and coronary arteries. Headache and hypotension are expected; erectile dysfunction drugs are a dangerous combination.
How do nitrates work?
Release nitric oxide, which relaxes vascular smooth muscle: venous dilation lowers preload, and coronary dilation improves blood flow to the heart muscle.
What are examples of nitrates?
Nitroglycerin, Isosorbide mononitrate and Isosorbide dinitrate.
What are the nursing considerations for nitrates?
Check blood pressure before and after doses. Contraindicated within 24 hours of sildenafil or vardenafil and 48 hours of tadalafil.