Nitroglycerin Sublingual and Oral Spray Nursing Pharmacology and Administration Review

This article will be a pharmacology and administration review for sublingual and oral spray nitroglycerin. 

What is nitroglycerin used for?

It used to relieve or prevent chest pain. It is part of the drug family of nitrates and because of this it causes vasodilation of blood vessels. This will lead to an increase in blood supply going to the heart, which will help with decreasing its workload.

As the nurse what can expect to see in your patient after they’ve received this medication?

• Facial flushing
• Burning or tingling under tongue
• Headache
• Dizzy
• Hypotension

When a patient is having chest pain you will want to:

• Notify MD
• Follow orders: most facilities have standing orders for when a patient starts to have chest pain. These are sometimes called chest pain protocols. They typically include:
  • Administering nitroglycerin and other drugs like morphine etc.
  • Placing patient on oxygen via nasal cannula to keep oxygen saturation within normal limits
  • Obtaining a 12-lead EKG
  • Drawing cardiac enzymes etc.

Things to Consider BEFORE Giving Nitro:

• Confirm the patient has no known allergy to nitroglycerin.
• Confirm the patient has NOT recently taken a phosphodiesterase inhibitor like Sildenafil (Viagra) or Tadalafil (Cialis)…this can lead to severe hypotension or even death.
• It’s not for patients with increased intracranial pressure.
• Confirm patient’s vital signs (especially blood pressure) is within parameters.

When giving nitroglycerin (sublingual or as oral spray) have the patient sit down because this medication causes dizziness.

Then obtain baseline vital signs. Remember this medication will lower blood pressure. It is important to make sure the patient’s SBP (systolic blood pressure) is within parameters. Most hospital’s protocols require the SBP to be greater than 90…if not contact the MD for further orders.

Also, if possible place the patient on a cardiac monitor to monitor for ST segment abnormalities like ST segment elevation or depression.

Video Demonstration on Administering Nitroglycerin Sublingual

How to Administer Sublingual Nitroglycerin

*The vial that contains the nitro tablets is dark brown. WHY? Nitroglycerin is very sensitive to heat, light or moisture. Therefore, be sure to protect the medication. In addition, once the vial is opened the tablets are good for 3 months.

1. Perform hand hygiene and don gloves.
2. Perform the patient’s rights.
3. Place one tablet under the tongue. Inform the patient NOT to swallow or chew the tablet, but let it dissolve under the tongue. In addition, have the patient NOT eat or drink anything for 10-15 minutes after administration.
4. After administration of the first dose, monitor the patient’s blood pressure very closely and their chest pain rating. Is it decrease or increasing?

1. If chest pain is still present and blood pressure is within parameters, after 5 minutes you may administer a 2^nd dose.
2. Again monitor the patient’s blood pressure very closely and chest pain rating. If chest pain is still present and blood pressure is within parameters, after 5 minutes you may administer a 3rd dose.
3. No more than 3 doses are given. Contact the physician for further orders.

How to Administer Oral Spray Nitroglycerin

*The vial is dark brown for the same reason as stated above. Never shake the bottle of spray and always keep it in an upright position. In addition, if you are using a new bottle of oral spray ALWAYS prime the bottle by spraying 5-8 sprays. TIP: Always prime the bottle away from your face and others.

1. Perform hand hygiene and don gloves.
2. Perform the patient’s rights.
3. Spray 1 spray under the tongue. Inform the patient to slightly hold their breath and not breathe in the medication while you are spraying it, and tell the patient to NOT rinse the mouth or eat/drink anything for 10 minutes.
4. Follow the same steps as above for steps 4-7.

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