nitroglycerin (Rx)

Acute anginal pain

Adult: SUBLING 0.3- 0.6 mg q5 min prn up to 3 doses; if pain persists, call 911; LIQUID 0.4- 0.8 mg sprayed on or under tongue, up to 3 doses q5 min; SPRAY 1- 2 sprays onto or under tongue q5 min; IV 5 mcg/min, increase by 5 mcg/min q3- 5 min up to 20 mcg/min; increase by 10- 20 mcg/min q3- 5 min prn up to 200 mcg/min Angina prophylaxis (short- acting)

Adult: SL cap (0.3- 0.4 mg) 5- 10 min before activity; TRANSLINGUAL SPRAY 1- 2 sprays 5- 10 min before activity Angina prophylaxis (long- acting)

Adult: PO extended release 2.5- 6.5 mg tid- qid, TAB SUSTAINED RELEASE 6.5 mg qid; OINT 0.5- 2 inches q6- 8 hr; TOP disc (patch) 5- 10 mg/24 hr, apply in am and remove in pm (intermittent dosing); intravenous doses may also be given

Available forms: SL tabs 0.3, 0.4, 0.6 mg; SL spray 0.4 mg/dose; transmucosal buccal tab 1, 2, 3 mg; oral caps 2.5, 6.5, 9, 13 mg; ext rel caps 2.5, 6.5, 9 mg; oint 2%; transdermal patch 2.5, 5, 7.5, 10, 15 mg/24 hr; transdermal disc 0.2, 0.4 mg/hr; inj 5 mg/ml

Implementation SL, buccal routes - Warn patient that SL form may cause tingling at contact; if it does not, tabs may be old, discard - SL tab: give 5 min before activity; instruct patient to place tab under tongue, allow to dissolve, do not swallow; if pain persists after 3 tabs, call 911 - Buccal tab: give 5 min before activity; place between lip and gum or cheek above gum line Topical route - Titrate to patient response; provide BP, pulse, ECG monitoring during beginning treatment - Place patch or ointment on clean, dry, hairless area; rotate sites; remove after 12- 14 hr to prevent tolerance; wash ointment from hands - After removing patch or ointment, wash area with soap and water Rectal route Covering fiber with plastic wrap, disposable glove or finger cot, lay finger alongside 1 inch dosing line on carton, squeeze tube until equal to 1 inch dosing line, insert covered finger no further than 1 st finger joint gently into anal canal and on sides, wash hands thoroughly, if too painful, apply directly to outside of anus Continuous IV infusion route Diluted in D5, D5 W, 0.9% NaCl for inf to 200- 400 mcg/ml depending on patient's fluid status, common dilution is 50 mg/250 ml use controlled inf device; use glass inf bottles, nonpolyvinyl chloride inf tubing; titrate to patient response; do not use filters

Y- site compatibilities: Acyclovir, alfentanil, amikacin, aminocaproic acid, aminophylline, amiodarone, amphotericin B lipid complex, amphotericin B liposome, amidulafungin, argatroban, ascorbic acid, atenolol, atracurium, atropine, azaTHIOprine, aztreonam, benztropine, bivalirudin, bleomycin, bmetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, cefamandole, ceFAZolin, cefmetazole, cefoncid, cefoperazone, cefotaxime, cefoTetan, cefOXitin, cefTAZidime, ceftizoxime, ceFTRIAXone, cefuroxime, cephalothin, cephapirin, chloramphenicol, chlorproMAZINE, cimetidine, cisatracurium, CISplatin, clindamycin, cloNIDine, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, dexamethasone, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doxacurium, DOXOrubicin, doxycycline, drotrecogin alfa, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluorouracil, folic acid, ganciclovir, gatifloxacin, gemcitabine, gemtuzumab, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone, HYDROMorphone, hydrOXyZine, IDArubicin, ifosfamide, imipenem- cilastatin, indomethacin, insulin (regular), irinotecan, isoproterenol, ketorolac, labetalol, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, meperidine, metaraminol, methicillin, methotrexate, methoxamine, methylodpate, methylPREDNISolone, metoclopramide, metronIDAZOLE, mezlocillin, micafungin, miconazole, midazolam, milrinone, minocycline, mitoXAN- trone, morphine, moxalactam, mycophenolate, nafcillin, nalbuphine, naloxone, nesiritide, netilmicin, niCARdipine, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, PACLItaxel, palonosetron, pamidronate, pancuronium, pantoprazole, papaverine, PEMETrexed, penicillin G potassium/sodium, pentamidine, pentazocine, PENTobarbital, PHENobarbital, phentolamine, phenylephrine, phytonadione, piperacillin, piperacillin- tazobactam, polymyxin B, potassium chloride, procainamide, prochlorperazine, promethazine, propofol, propranolol, protamine, pyridoxine, quiNIDine, quinupristin- dalfopristin, ranitidine, remifentanil, ritodrine, rocuronium, sodium bicarbonate, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiamine, thiopental, thiotepa, ticarcillin, ticarcillinclavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRSTine, vinorelbine, voriconazole, warfarin, zoledronic acid Y-site incompatibilities: Alteplase