Category Archives: Nitroglycerin

Defining the Proper Role for Selfadministered Sublingual Nitroglycerin (15)

Defining the Proper Role for Selfadministered Sublingual Nitroglycerin (15)Conclusions
The six cases we describe point up some of the potentially adverse effects of sublingual nitroglycerin as it is commonly prescribed: hypotension and syncope during acute myocardial infarction as well as during noncardiac chest pain; delay in seeking appropriate medical care during the early hours of acute myocardial infarction and in the course of early postinfarction ischemic rest pain; worsening of nonischemic conditions such as paroxysmal supraventricular tachycardia; and undue anxiety over being without nitroglycerin tablets. Our data indicate that patient use of the drug is often incorrect, and that drawing diagnostic conclusions from the patients response to nitroglycerin will often be misleading. Cheap Diskus Advair

Defining the Proper Role for Selfadministered Sublingual Nitroglycerin (14)

With regard to the potential importance of sublingual nitroglycerin in preventing sudden death during an ischemic episode, systematically acquired objective data are obviously difficult, if not impossible, to obtain. It should be noted, however, that frequent episodes of transient, even prolonged, ischemia are very common in patients with stable coronary artery disease, and in the overwhelmingly large majority of instances they terminate spontaneously with absolutely no sequelae. buy ventolin inhalers

Defining the Proper Role for Selfadministered Sublingual Nitroglycerin (13)

Defining the Proper Role for Selfadministered Sublingual Nitroglycerin (13)Although patients with stable coronary artery disease are also subject to sublingual nitroglycerin-induced hypotension, patients with unstable angina and acute myocardial infarction seem especially prone to this danger. Possible factors involved in this increased sensitivity include concomitant right ventricular infarction during inferior infarction and paradoxic nitroglycerin-induced coronary narrowing. proventil inhaler

Defining the Proper Role for Selfadministered Sublingual Nitroglycerin (12)

One-third of the patients who carried nitroglycerin with them at all times had not used it at all during the preceding year. buy yasmin online
Of the patients surveyed, 61 percent felt that nitroglycerin might be lifesaving, and 34 percent thought it might prevent a heart attack. Among the physicians, approximately one third subscribed to the view that sublingual nitroglycerin might abort an acute myocardial infarction or decrease its size or prevent sudden death during ischemia. Although sublingual nitroglycerin is clearly capable of providing symptomatic relief from exertional or rest angina, what evidence is there that it can provide critical, long-lasting benefit by modifying the course of an acute myocardial infarction or preventing sudden death?

Defining the Proper Role for Selfadministered Sublingual Nitroglycerin (11)

Defining the Proper Role for Selfadministered Sublingual Nitroglycerin (11)This, despite the fact that the patient population is made up overwhelmingly of middle-class, employed individuals, 89 percent of whom described themselves as being “very certain” or “fairly certain” of how to use nitroglycerin. ventolin 100 mcg
Sixty-eight percent of the physicians felt that giving the patient a sense of security was a real benefit of nitroglycerin, and 48 percent of the patients claimed that having the drug indeed gave them a sense of security. Yet one must question whether the patients’ need for such reassurance may not have been artificially created by their being told by their physicians that they should have nitroglycerin available at all times. In fact, 88 percent of the patients stated that they would be anxious to some extent to be away for a weekend without their nitroglycerin, and in 47 percent the degree of anxiety would be “extreme” or “a lot.”

Defining the Proper Role for Selfadministered Sublingual Nitroglycerin (10)

Discussion
Our survey has documented a high prevalence of the use of as needed nitroglycerin, with 84 percent of physicians routinely prescribing it to patients after a myocardial infarction, 79 percent of patients having it available, and 83 percent of these keeping it with them at all times. Only a relatively small 11 percent of the patients had ever had an adverse reaction to nitroglycerin. In most cases this consisted of headache, and only 3 percent of the patients had suffered dizziness or fainting.

Defining the Proper Role for Selfadministered Sublingual Nitroglycerin (9)

Defining the Proper Role for Selfadministered Sublingual Nitroglycerin (9)Physician Survey
Of a total of 121 physicians sampled, 102 (84 percent) indicated that they routinely prescribed sublingual nitroglycerin to patients after an acute myocardial infarction for use as needed, even in the absence of a recurring anginal syndrome. This was true of 85 percent of the 104 physicians surveyed at the cardiology convention, and of 82 percent of the 17 physician members of the HMO internal medicine department. buy birth control online
The convention group physicians described their professional practice as follows: 62 percent, clinical cardiology; 11 percent, cardiology fellowship; 10 percent, academic cardiology; 10 percent, internal medicine/cardiology; 6 percent, internal medicine; and 1 percent, other. The HMO group was composed of 82 percent internists and 18 percent cardiologists.

Defining the Proper Role for Selfadministered Sublingual Nitroglycerin (8)

However, the following percentages of patients indicated they had used or would use nitroglycerin for other indications: 39 percent, attack of fast or strong heartbeat; 36 percent, feeling that they were about to faint; 38 percent, sudden weakness; 27 percent, attack of dizziness; 51 percent, sudden shortness of breath; 61 percent, weakness or numbness in the left arm; and 29 percent, attack of severe nausea with abdominal discomfort. A full 57 percent of the patients who had sublingual nitroglycerin had used it or would use it for one of the first four (inappropriate) symptoms on the above list. birth control yasmin

Defining the Proper Role for Selfadministered Sublingual Nitroglycerin (7)

Defining the Proper Role for Selfadministered Sublingual Nitroglycerin (7)A full 37 percent of the patients who had nitroglycerin tablets did not use them at all in the previous year, and an additional 13 percent used them no more than three times. Of the patients who carried nitroglycerin with them at all times, 32 percent had not used the drug at all in the previous year. flovent inhaler
Knowledge of Proper Use of Nitroglycerin: Patients were asked how certain they felt about how and when to use nitroglycerin. “Very certain” was chosen by 50 percent, “fairly certain” by 39 percent, while only 11 percent of the sample indicated that they were “not certain at all.”

Defining the Proper Role for Selfadministered Sublingual Nitroglycerin (6)

Patients were asked how soon the tablets helped: 58 percent, within 5 minutes; 15 percent, 10 to 15 minutes; 3 percent, 20 to 30 minutes; and 24 percent, “hard to say.” buy cheap antibiotics
When asked how completely their symptoms were relieved within the above time period, 59 percent answered “completely” and 41 percent answered “partly.” The combination of “complete relief within 5 min” was indicated by 45 percent of the patients who used nitroglycerin.

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