Question

Mr. Johnson a 80 yo male who is being admitted for a possible MI after he had taken his 3 sublingual pills of Nitroglycerin (NTG) without relief of his chest pain. In the ED his chest pain was relieved with an intravenous solution of nitroglycerin. However, all is lab work and ECG came back negative for MI. He will be weaned off of his IV nitro and started on NTG transdermal patches 10mg/24 hrs. He will also be prescribed diltiazem 30mg once a day.

1. How are you the RN going to wean the NTG solution off, and place the NTG patch?

2. When will you give him his first dose of diltiazem?
3. He has a question for you about why his NTG pills at home may not have worked? Based on what you know about NTG tablets explain why his tablets may not have worked.

4. Mr. Johnson is told to only wear the NTG patch for 12 hrs at a time. Why?

Answer 1

1)Weaning is necessary for NTG because even though it relaxes heart muscles continuous infusion can cause rebound spasm of coronary artery. Therefore , it should be kept off atleast for 8 hours then can be started on transdermal patch.

2)Diltiazem can started after 48 hours followed by 4 weeks of oral therapy.

3)Its a common side effect of NTG pills that it won't work if taken very regularly. So it should be taken only during pain.

4)Wearing NtG patch for longer hours can have similar effects of the tablets. Our body will get used to it and won't work effectively.