CH 6, 23, 24 Drugs
Cromolyn Sodium
ACTION USE CONTRAINDICATIONS PRECAUTIONS ADVERSE REACTIONS DOSAGE & ROUTE PATIENT CARE
Flonase
ACTION USE CONTRAINDICATIONS PRECAUTIONS ADVERSE REACTIONS DOSAGE & ROUTE PATIENT CARE
Rhinocort
ACTION USE CONTRAINDICATIONS PRECAUTIONS ADVERSE REACTIONS DOSAGE & ROUTE PATIENT CARE
digitalis (digoxin)
ACTION - Digoxin (Lanoxin) strengthens the heart muscle, increases the force and velocity of myocardial systolic contrac- tion (positive inotropic effect), slows the heart rate (negative chronotropic effect) through the SA node, and de- creases conduction velocity through the atrioventricular (AV) node USE - Congestive heart failure, atrial fibrillation, atrial flutter, paroxysmal atrial tachycardia. CONTRAINDICATIONS - Contraindicated in patients with known hypersensitivity to any of the ingredients and in ventricular fibrillation. PRECAUTIONS 1. Anorexia, nausea, vomiting, and arrhythmias may be indications of digitalis intoxication. 2. Use caution in patients with renal disease, severe respiratory disease, acute myocardial infarction, AV block, or hypothyroidism. Also use caution in geriatric patient and during pregnancy/lactation ADVERSE REACTIONS - Reactions can include unifocal or multiform ventricular premature contractions, ventricular tachycardia, atri- oventricular dissociation, atrial tachycardia, excessive slowing of the pulse (clinical signs of digitalis overdose), complete heart block, anorexia, nausea, vomiting, diarrhea, blurred vision, headache, weakness, dizziness, apa- thy, psychosis, gynecomastia, maculopapular rash, drowsiness, confusion, or depression. DOSAGE & ROUTE - The dosage and route of administration are determined by the physician and are individualized for each patient. PATIENT CARE - Assess the apical pulse for one minute before administering digitalis drugs. Withhold the medication if the pulse is below 60 or the minimum specified by the prescribing physician. Monitor intake and output ratio, daily weight, liver function studies, serum electrolytes, creatinine, and drug levels. Be alert for signs of digitalis toxicity and hypokalemia. Evaluate the therapeutic response of medication (decreased edema, weight loss, increased urine output, improved heart rate, and rhythm). SPECIAL CONSIDERATIONS - Potassium-depleting corticosteroids and diuretics may be major contributing factors to digitalis toxicity. - Rapid intravenous administration of calcium may produce serious arrhythmias in patients receiving digitalis. - Quinidine, verapamil, and amiodarone cause a rise in serum digoxin concentration, with the implication that digitalis intoxication may result. - Antacids, kaolin-pectin, sulfasalazine, neomycin, cholestyramine, and certain anticancer drugs may interfere with intestinal digoxin absorption, resulting in unexpectedly low serum concentration. - The additive effects of beta-adrenergic blockers or calcium channel blockers and digitalis can result in complete heart block. - There are numerous precautions and drug interactions associated with digitalis drugs. Please refer to a current drug reference source for more information.
heparin
ACTION - Prevents conversion of fibrinogen to fibrin. USES - Use in anticoagulant therapy in prophylaxis and treatment of venous thrombosis and its extension. Use also for prevention of postoperative deep venous thrombosis and pulmonary embolism, prevention of clotting in arterial and heart surgery, prophylaxis and treatment of peripheral arterial embolism, atrial fibrillation with embolization, disseminated intravascular clotting syndrome, as an anticoagulant in blood transfusions, extracorporeal circulation, and dialysis procedures, and in blood samples for laboratory purposes. CONTRAINDICATIONS - Contraindicated in patients with known hypersensitivity to any of its ingredients and in patients with severe thrombocytopenia and uncontrollable active bleeding. CAUTION 1. Use with extreme caution in patients with hemophilia, leukemia with bleeding, peptic ulcer disease, hepatic disease (severe), renal disease (severe), blood dyscrasias, pregnancy, severe hypotension, subacute bacterial endocarditis, or acute nephritis. 2. Heparin is not intended for intramuscular use. 3. Hemorrhage can occur at almost any site in patients receiving heparin. 4. Do not massage injection site. ADVERSE REACTION - Reactions include hemorrhage; local irritation, erythema, mild pain, hematoma, or ulceration may follow deep subcutaneous injection. Hypersensitivity reaction may include chills, fever, and urticaria. Other adverse reactions are asthma, rhinitis, lacrimation, headache, nausea, vomiting, and anaphylactoid reactions, including shock DOSAGE AND ROUTE - The dosage and route of administration (IV or subcutaneous) are determined by the physician and are individualized for each patient. IMPLICATIONS FOR PATIENT CARE - Parenteral drug products should be inspected visually for particulate matter and discoloration prior to adminis- tration. Slight discoloration does not alter potency. Never administer by intramuscular injection. The dosage of heparin should be adjusted according to the patient's coagulation test results; these should be monitored very carefully. Be aware of signs of bleeding: petechiae, ecchymosis, black tarry stools, bleeding gums, and hematuria. Be alert for signs of adverse reactions. SPECIAL CONSIDERATIONS - Heparin sodium is not effective by oral administration and should be given by intermittent intravenous injection, intravenous infusion, or deep subcutaneous injection. ORAL ANTICOAGULANTS - Anticoagulants that are administered orally do not produce an immediate effect. Their action is usually evident within 12 to 24 hours of administration. As with other anticoagulants, the use of these drugs may produce a cu- mulative effect; therefore, dosages must be individualized and based on the patient's clotting time, using a blood coagulation test
antihistamines
Actions Antihistamines appear to compete with histamine for cell receptor sites on effector cells. Histamine-related allergic reactions and tissue injury are blocked or diminished in intensity. Uses The primary use for antihistamine agents is the treatment of allergy symptoms that have resulted from the release of histamine. They are effective in the treatment of perennial and seasonal allergic rhinitis, contact dermatitis, urticaria, pruritus, for amelioration of allergic reactions to substances such as blood, plasma, insect stings, plant poisons, and as an adjunctive therapy during anaphylactic shock. Some antihistamines are used for the prevention and control of motion sickness and others are used in combination cold remedies to decrease mucus secretion and at bedtime for sedation. Contraindications Antihistamines are contraindicated in patients who are known to be hypersensitive to any of the ingredients. They should not be used in newborn or premature infants and during breast-feeding. Caution Antihistamines should be used with considerable caution in patients with narrow-angle glaucoma, stenosing peptic ulcer, liver function problems, pyloroduodenal obstruction, symptomatic prostatic hyperplasia, or bladder-neck obstruction. Adverse Reactions The most frequent adverse reactions to antihistamines are sedation, sleepiness, dizziness, disturbed coordina- tion, epigastric distress, and thickening of bronchial secretions. Other adverse reactions are dryness of mouth, nose, and throat, as well as hypotension, headache, palpitations, nervousness, tremor, irritability, vertigo, tinnitus, anorexia, nausea, vomiting, diarrhea, constipation, wheezing, and nasal stuffiness. Dosage and Route The dosage and route of administration are determined by the manufacturer, but a physician should be consulted when needed. See Table 24-1 for selected antihistamines. Implications for Patient Care You should know that many antihistamines have an atropine-like action and, therefore, should be used with caution in patients with a history of bronchial asthma, increased intraocular pressure, hyperthyroidism, cardiovascular disease, or hypertension. Special Considerations - The action of oral anticoagulants may be diminished by antihistamines. - Antihistamines have additive effects with alcohol and other CNS depressants (e.g., tranquilizers, sedatives, hypnotics). - Antihistamines are most likely to cause dizziness, sedation, and hypotension in patients over 60 years of age. - Antihistamines should only be taken when needed. One may develop tolerance to certain antihistamines.
decongestants
Actions Decongestants act by stimulating alpha-adrenergic receptors of vascular smooth muscle. As a result, dilated arterioles in the nasal mucosa are constricted. This reduces blood flow to the affected area, slows the formation of mucus, improves drainage, and opens obstructed nasal passages. Uses For the temporary relief of nasal congestion associated with the common cold, hay fever, and other upper respiratory allergies, and sinusitis. Contraindications Decongestants are contraindicated in patients who are allergic to adrenergic agents or have narrow-angle glaucoma, and patients who are taking MAO inhibitors or tricyclic antidepressants. Adverse Reactions Reactions include rebound nasal congestion, dryness and stinging of the mucosa, sneezing, light-headedness, headache, anxiety, palpitations, drowsiness, nausea, vomiting, and anorexia. Dosage and Route The dosage and route of administration are determined by the manufacturer, but a physician should be consulted when needed. See Table 24-2 for selected decongestants. Implications for Patient Care Because most decongestants are taken as over-the-counter medications, the implications for patient care mainly involve teaching the patient about the medication. Special Considerations - Topical decongestants must be administered correctly to avoid systemic absorption. - Physician should be notified if irregular heartbeat, insomnia, dizziness, or tremors occur. - Environmental humidification may decrease drying of the mucosa
Expectorants
Actions Expectorants enhance the output of lower respiratory tract fluids and help make them less viscid. This promotes and facilitates the removal of mucus. Uses Use an expectorant to help loosen phlegm (mucus) and thin bronchial secretions to make cough more productive. Contraindications Expectorants are contraindicated in patients who are hypersensitive to any of the ingredients and those with persistent cough. Adverse Reactions Reactions include drowsiness, nausea, vomiting, and anorexia. Dosage and Route The dosage and route of administration are determined by the physician.
folic acid (b9)
Actions It increases red blood cell, white blood cell, and platelet formation in megaloblastic anemias. Uses Folic acid is used for megaloblastic or macrocytic anemia caused by folic acid deficiency, as well as liver disease, alcoholism, hemolysis, and intestinal obstruction. Use caution during pregnancy. Contraindications Folic acid is contraindicated in patients with hypersensitivity, anemias other than megaloblastic or macrocytic anemia, and vitamin B12 deficiency. Adverse Reactions Bronchospasm. Dosage and Route Megaloblastic or macrocytic anemia: Oral, IM, SC (adult and child over 4 years of age) 1 mg every day times 4 to 5 days. Implications for Patient Care Assess folate blood levels. Store medication in a light-resistant container. Evaluate therapeutic response and nutritional status of patient
antitussives
Actions Nonnarcotic antitussive agents anesthetize the stretch receptors located in the respiratory passages, lungs, and pleura by dampening their activity and thereby reducing the cough reflex at its source. Narcotic antitussive agents depress the cough center that is located in the medulla, thereby raising its threshold for incoming cough impulse. Uses Antitussives are used for symptomatic relief of cough. Contraindications Antitussive agents are contraindicated in individuals who are hypersensitive to any of the ingredients. They should not be used by newborn or premature infants, pregnant women, and during breast-feeding. Adverse Reactions Nonnarcotic antitussive agents may produce sedation, headache, mild dizziness, pruritus, nasal congestion, constipation, nausea, and gastrointestinal (GI) upset. Narcotic antitussive agents may produce nausea, vomiting, constipation, light-headedness, and drowsiness. Dosage and Route The dosage and route of administration are determined by the manufacturer, but a physician should be consulted when needed. See Table 24-3 for selected antitussives. Implications for Patient Care Because most nonnarcotic antitussives are taken as over-the-counter medications, the implications for patient care mainly involve teaching the patient about the medication. For narcotic antitussives, you should monitor the patient for signs of improvement, adverse reactions, dependency, and tolerance
Cyanocobalamin (Vitamin B12)
Actions Replaces vitamin B12 that the body would normally absorb from the diet. Uses It is used for vitamin B12 deficiency, pernicious anemia, and vitamin B12 malabsorption syndrome. Contraindications Do not use in patients with hypersensitivity or optic nerve atrophy. Use caution during pregnancy and lactation. Adverse Reactions Flushing, optic nerve atrophy, diarrhea, congestive heart failure, peripheral vascular thrombosis, pulmonary edema, itching, rash, and hypokalemia are possible reactions. Dosage and Route Pernicious anemia: IM (adult) 100 to 1000 μg every day for two weeks, then 100-1000 μg every month. Implications for Patient Care Assess gastrointestinal function, potassium blood level, and complete blood count. Be aware of signs of adverse reactions. Evaluate therapeutic response and nutritional status of patient
montelukast sodium (singulair)
Actions Singulair is a selective and orally active leukotriene receptor antagonist that inhibits the cysteinyl leukotriene CysLT1 receptor. It is able to block leukotriene action in the lung, resulting in less constriction of the bronchial tissue and less inflammation. Uses It is indicated for the prophylaxis and chronic treatment of asthma in adults and pediatric patients 6 years of age and older. Contraindications Montelukast Sodium is contraindicated in patients with hypersensitivity to any component of this product. Precautions Singulair is not indicated for use in the reversal of bronchospasm in acute asthma attacks, including status asthmaticus. Patients should be advised to have appropriate rescue medication available. Singulair should not be used as monotherapy for the treatment and management of exercise-induced bronchospasm. Patients who have exacerbations of asthma after exercise should continue to use their usual regimen of inhaled medication. Adverse Reactions Reactions include asthenia, fatigue, fever, abdominal pain, dyspepsia, gastroenteritis, dizziness, headache, nasal congestion, cough, influenza, and rash. Less common side effects include increased bleeding tendency, allergic reactions, behavior and mood re- lated changes (agitation including aggressive behavior, bad/vivid dreams, depression, feeling anxious, hallucinations, irritability, restlessness, suicidal thoughts and actions including suicide, tremor, trouble sleeping), nose bleed, joint pain, and muscle aches. Dosage and Route The dosage for adults and adolescents 15 years of age and older is one 10-mg tablet daily to be taken in the evening. The dosage for pediatric patients 6 to 14 years of age is one 5-mg chewable tablet daily to be taken in the evening. Implications for Patient Care The medical assistant should monitor the patient for improvement and adverse reactions. Patients on Singulair should be monitored for suicidality and changes in mood or behavior. Assist the patient and his or her family to identify and eliminate or minimize factors that trigger symptoms.
bronchodilators
Actions Sympathomimetics act on beta-2 adrenoreceptors to relax smooth muscle cells of the bronchi. This response reduces edema in the bronchial mucosa. They also produce a vasoconstriction response throughout the body by stimulating alpha receptors. Some sympathomimetics also stimulate beta-1 receptors and this results in an increased heart rate and its force of contraction. Xanthine bronchodilators relax smooth muscle of the bronchial airways and pulmonary blood vessels by blocking phosphodiesterase, which increases adenosine monophos- phate (AMP). By preventing the breakdown of cyclic AMP, smooth muscles relax and bronchodilation occurs, thus relieving dyspnea. They may also produce cardiac stimulation, coronary vasodilation, stimulation of skeletal muscles, cerebral stimulation, and diuresis. - Beta -2 adrenergic agonists work by stimulating beta-2 receptors in the muscles that line the airways, which causes them to relax and allows the airways to dilate (widen). These agents act by engaging the beta-2 adrenergic receptors on smooth muscle of bronchial tissue, reliev- ing bronchospasm and reducing airway resistance. Uses Bronchodilators are used in the prevention and relief of bronchospasm in patients with asthma, bronchitis, and emphysema. They may be short-acting beta 2-agonists or long-acting beta 2-agonists. Short-acting beta 2-agonists are called reliever or rescue medicines because they stop asthma symptoms very quickly by opening the airways. They work within 20 minutes and last four to six hours. They are also the medicines to use 15 to 20 minutes before exercise to prevent exercise-induced asthma symptoms. Long-acting beta-2 agonists are usually prescribed for moderate to severe persistent asthma patients or for patients with chronic obstructive pulmonary disease (COPD). Their duration of action is approximately 12 hours. Examples of short-acting beta 2-agonists are: albuterol sulfate (Ventolin, Accuneb), levalbuterol (Xoponex, Xoponex), albuterol sulfate and ipratropium bromide combination (DuoNeb solution), and Duoneb. Examples of long-acting beta 2-agonists (LABA) are: salmeterol (Serevent), formoterol (Foradil). Com- bination medications: salmeterol and fluticasone (Advair Diskus); formoterol and budesonide (Symbicort); formoterol and mometasone (Dulera). These contain both the long-acting beta agonist and an inhaled corticosteroid. Contraindications Bronchodilators are contraindicated in patients who are hypersensitive to any of the ingredients. Adverse Reactions Palpitations, increase in blood pressure, tremors, nausea, vomiting, dizziness, heartburn, nervousness, urticaria, and headache are possible reactions. Dosage and Route The dosage and route of administration are determined by the physician. See Table 24-5 for selected sympatho- mimetic bronchodilators and Table 24-6 for selected xanthine bronchodilators. Implications for Patient Care You should be aware that many sympathomimetic bronchodilators might also stimulate beta-1 receptors located in the heart. They could be dangerous to use in patients who have heart disease. Monitor all patients for changes in cardiac function and blood pressure. With xanthine bronchodilators, monitor the patient for disruption of cardiac function, insomnia, and hyperexcitability. Be aware of increased potential for convulsive activity. The serum levels of the medication should be checked on a regular basis. Therapeutic range should be 10 to 20 mcg/mL. Special Considerations - Sympathomimetic bronchodilators should not be used with MAO inhibitors because sympathomimetic activity could be increased and hypertensive crisis might occur. - Patients using antihistamines, tricyclic antidepressants, and thyroid hormone may experience greater sympathomimetic activity with the use of a sympathomimetic bronchodilator. - Xanthine bronchodilators may enhance CNS stimulation of ephedrine, sympathomimetics, and amphetamines. - Certain antibiotics (erythromycin, lincomycin, and clindamycin) may increase blood levels of xanthines. - Xanthines may interact with beta-blocking agents, digitalis, anticoagulants, lithium, and furosemide.
thrombolytic agents
CONTRAINDICATIONS - Avoid use with hypersensitivity, active internal bleeding, recent (within two months) cerebrovascular accident, intracranial or intraspinal surgery, intracranial neoplasm, or severe uncontrolled hypertension. ADVERSE REACTIONS - Bleeding, allergic reactions, anaphylactic and anaphylactoid reactions, and fever are some reactions. pg. 415
aspirin (antiplatelet drugs)
CONTRAINDICATIONS - This medicine should not be used in patients with hypersensitivity, gastrointestinal bleeding, bleeding disorders, children under 3 years of age, children with flulike symptoms, pregnancy, lactation, vitamin K deficiency, and peptic ulcer PRECAUTIONS - Use caution in patients with anemias, hepatic or renal disease, and Hodgkin's disease ADVERSE REACTIONS - Reactions can include thrombocytopenia, agranulocytosis, leukopenia, neutropenia, hemolytic anemia, in- creased prothrombin time, drowsiness, dizziness, confusion, convulsions, headache, flushing, hallucinations, coma, nausea, vomiting, GI bleeding, heartburn, anorexia, rash, urticaria, bruising, ototoxicity, tinnitus, hearing loss, rapid pulse, hyperpnea, hypoglycemia, hypokalemia, hepatotoxicity, renal dysfunction, visual changes, and edema. SPECIAL CONSIDERATIONS - Patients taking anticoagulant drugs should not take aspirin unless prescribed by their physician. Prothrombin time should be performed on a regular basis and monitored carefully. Antacids, steroids, and urinary alkalizers may decrease the effectiveness of the drug. Anticoagulants, insulin, and methotrexate may increase the effectiveness of the drug
Epoetin Alfa (Epogen)
Epogen is an erythropoiesis-stimulating agent (ESA) that stimulates red blood cell production (erythropoeisis). ESAs, structurally and biologically, are similar to naturally occurring protein erythropoietin. Actions It stimulates the production of red blood cells. Uses Used for anemia associated with chronic renal failure or in AIDS patients. Contraindications Do not use in patients with uncontrolled hypertension, known hypersensitivity to mammalian cell-derived products, and known hypersensitivity to albumin (human). Adverse Reactions Reactions include hypertension, headache, arthralgia, nausea, edema, fatigue, diarrhea, vomiting, chest pain, skin reactions, asthenia, dizziness, clotted vascular access, seizure, and myocardial infarction. Dosage and Route Starting dose: 50 to 100 U/kg three times weekly IV for dialysis patients; IV or SC for nondialysis patients. Reduce dose when (1) target range is reached, or (2) hematocrit increases above four points in any two-week period. Increase dose if hematocrit does not increase by five to six points after eight weeks of therapy, and hematocrit is below target range. Implications for Patient Care Carefully monitor blood pressure for signs of hypertension. Assess hematocrit for therapeutic range. Do not shake the container, as shaking may denature the glycoprotein, rendering it biologically inactive. Inspect parenteral drug product for particulate matter and discoloration. Do not use vial if either or both are apparent. Use aseptic technique. Use only one dose per vial; do not reenter vial. Discard unused portions. Do not administer in con- junction with other drug solutions.
Montelukast Sodium
Singulair - leukotriene receptor antagonist ACTION USE CONTRAINDICATIONS PRECAUTIONS ADVERSE REACTIONS DOSAGE & ROUTE PATIENT CARE
phenylephrine hcl (neo-synephrine 1% injection)
USUAL DOSAGE - IM, SC: 2 to 5 mg ADVERSE REACTIONS - Headache, reflex bradycardia, excitability, restlessne
lidocaine hcl (xylocaine hcl)
USUAL DOSAGE - IM: 2 mg/lb (4.3 mg/kg) of 10% solution as needed ADVERSE REACTIONS - Light-headedness, visual disturbances, tinnitus, muscle twitches
warfarin sodium (Coumadin)
USUAL DOSAGE - Oral (Adult): 40 to 60 mg the first day, followed by 2 to 10 mg daily ADVERSE REACTIONS - Hemorrhage, alopecia, dermatitis, urticaria PG. 412
papaverine hcl
USUAL DOSAGE - Oral (sustained-release): 150 mg every 8 to 12 hours ADVERSE REACTIONS - Nausea, abdominal distress, anorexia, constipation, headache, drowsiness, sweating
isoxsuprine hcl (vasodilan)
USUAL DOSAGE - Oral: 10 to 20 mg three to four times daily IM: 5 to 10 mg two to three times daily ADVERSE REACTIONS - Occasional hypotension, tachycardia, nausea, dizziness, chest pain, rash
propranolol hcl (inderal)
USUAL DOSAGE - Oral: 10 to 30 mg three to four times daily before meals and at bedtime ADVERSE REACTIONS - Light-headedness, mental depression and insomnia, nausea, vomiting, visual disturbances. Most adverse reactions are mild and transient
flecainide acetate
USUAL DOSAGE - Oral: 100 mg every 12 hours with increases of 50 mg b.i.d. every 4 days until efficacy is achieved ADVERSE REACTIONS - Chest discomfort and tinnitus, leg cramps, blurred vision, ataxia, dry mouth, nasal congestion, nausea
quinidine sulphate (extentabs)
USUAL DOSAGE - Oral: 200 to 300 mg three to four times daily ADVERSE REACTIONS - Tinnitus, visual disturbances, nausea, vomiting, headache, vertigo. Hypersensitivity to the drug may cause angioedema, acute asthmatic episode, and sometimes vascular collapse.
disopyramide (norpace); (norpace cr)
USUAL DOSAGE - Oral: 600 mg/day in divided doses (150 mg every 6 hours) Less than 110 pounds (50 kg): 100 mg every 6 hours Oral: 600 mg/day in divided doses (300 mg every 12 hours) Less than 110 pounds (50 kg): 200 mg every 12 hours ADVERSE REACTIONS - Hypotension, nausea, congestive heart failure, urinary retention, headache Dry mouth, malaise, constipation, blurred vision, dry nose, eyes, and throat
cyclandelate (cyclospasmol)
USUAL DOSAGE - Oral: Initial dose, 1200 to 1600 mg per day in divided doses before meals and at bedtime; with clinical response, reduce dose by 200 mg decrements until maintenance dose (400 to 800 mg/day) is reached ADVERSE REACTIONS - Gastrointestinal distress, mild flush, headache, feeling of weakness, or tachycardia
enoxaparin (lovenox)
USUAL DOSAGE - SC (Adult): Prophylaxis before knee or hip surgery: 30 mg twice daily starting within 24 hours post-op and continued for 7 to 10 days or until ambulatory (up to 14 days) Prophylaxis before abdominal surgery: 40 mg twice daily starting within 24 hours post-op and continued for 7 to 10 days or until ambulatory (up to 14 days) Systemic anticoagulants: 1 mg/kg every 12 hours ADVERSE REACTIONS - Hemorrhage, anemia, thrombocytopenia, dizziness, headache, nausea, vomiting, pruritus, rash, urticaria, fever
isosorbide dinitrate (isordil)
USUAL DOSAGE - Sublingual: 2.5 to 5 mg every 3 hours Chewable: 5 mg initially every 2 to 3 hours Oral: 5 to 20 mg four times daily Oral (sustained-release): 40 mg every 6 to 12 hours ADVERSE REACTIONS - Headache, hypotension, cutaneous vasodilation with flushing, transient episodes of dizziness
nitroglycerin (nitrolingual spray) (nitrostat) (nitro dur transderm)
USUAL DOSAGE - Topical: Spread in a thin layer over a 2- to 6-inch area every 3 to 4 hours when needed Sublingual: 0.15 to 0.6 mg under tongue as needed for acute angina Oral (sustained-release): 2.5 mg three to four times daily Transdermal: 2.5 to 20 mg released over a 24-hour period Lingual aerosol: 1 to 2 metered doses onto or under the tongue Transmucosal: 1 mg placed on the oral mucosa between cheek and gum ADVERSE REACTIONS - Headache, hypotension, cutaneous vasodilation with flushing, and occasional drug rash or exfoliative dermatitis