GLYCERAL TRINITRATE, DIGOXIN, and DOBUTAMINE

GLYCERAL TRINITRATE 

Mechanism of action

The first step in the conversion of nitrates into nitric acid is to stimulate cyclic guanosine monophosphate (cGMP) dephosphorylation, which lowers the intracellular calcium concentration of the cells. This results in depolarization of the myosin chains, which relaxes the vascular smooth muscle and the myosin light chain in the cardiac muscle.

Indication

• Angina pectoris
• Cyanide poisoning
• IV for CHF

Dose

Adult:

• Sublingual: 0.3-1mg prn
• By mouth: 5-15mg/day prn
• Transdermal patch: 5-25mg
• Sublingual spray: 0.4 - 0.8mg / s * nrav
• Buccal: 1 - 2mg / 4 * hours

Contraindication

Severe anemia, Increased intracranial pressure, head trauma, Cerebral hemorrhage, Closed- angle glaucoma, Severe anaemia

Side Effect

Headache, Hypotension, Postural hypotension, Tachycardia, Lightheadedness, Diaphoresis, Tolerance, Withdrawal symptoms, Drug rashes, Facial flushing, Tachycardia.

Nursing Consideration

• One sublingual tablet should be administered, and if pain relief is insufficient, provide additional tablets at 5-minute intervals; however, no more than three tablets should be administered in a 15-minute span.
• Sustained-Release buccal tablets should be positioned above the incisors between the lip and gum or between the cheek and gum, where they will slowly dissolve over three to five hours.
• Sustained-Release tablet or capsule should be taken with a full glass of water on an empty stomach (one hour before or two hours after meals). Make sure you completely swallow it.
• Canister of translingual spray shouldn't be shaken. Spray beneath or on the tongue, preferable. Avoid inhaling spray.
• Use the dose-determining transdermal ointment applicator (paper application patch) included in the package to squeeze the required dose onto it.
• Continuous infusion controlled precisely by an infusion pump should be used to administer IV infusions. Hemodynamic monitoring must be meticulous and ongoing during IV dosage titration.
• Don't stop using this drug without consulting a doctor first.
• Nitroglycerine tolerance develops over time, and blood vessels do not react to Nitroglycerine as well. To reduce tolerance, patches or topical ointments are removed for 12 hours each day.

DIGOXIN

Derived from the dried leaf of the Digitalis purpurea or lanata foxglove plant.

Mechanism of Action

• Remove sodium from (enters potassium).
• More Ca entering the cell.
• Strong heartbeat contraction
• Sodium-potassium ATPase is inhibited.
• Inhibiting the action of the Na K pump.
• Incorporates Na' K ATPase.

Indication: 

Atrial flutter, paroxysmal atrial tachycardia, and cardiogenic shock are all symptoms of CHF.

Dose:

(available as: inj 50mcg / m * L Tab 0.125mg, 0.25 mg)

0.125 mg-0.25 mg once a day;1.V:Loading dose: 0.5-1 mg (total)

Contraindications: 

• Myocarditis,
• MI,
• Lactation,
• Pregnancy,
• Ventricular fibrillation.

Side Effects:

Heart irregularities, sadness, bewilderment, and disorientation, vision issues, blurry vision, and anorexia

Nursing consideration

• Without eating, an oral dose should be administered. If the patient can't swallow it whole, crush it and mix it with some liquid or food.
• Before delivering a medicine, vital signs should be monitored often, especially the pulse for a full minute while recording the overline rate, rhythm, and quality. If your pulse falls outside of the prescribed range, call your doctor. While receiving initial digitalization therapy, keep an eye on your ECG for changes in rhythm and rate.
• Patients taking IV digoxin should periodically have their blood pressure checked. Each dose of the medication, which must be administered gradually through an IV infusion, can take up to 30 minutes to complete.
• When starting the dose or increasing the dose, keep a close eye out for any toxicity symptoms (anorexia, nausea, vomiting, cardiac arrhythmias, headaches, hypokalemia, hypomagnesemia, hypercalcemia, etc.).
• Keep an eye on daily weights and the ratios of input to output. Throughout treatment, check for peripheral oedema.
• Check serum potassium, magnesium, and calcium levels in accordance with the lab report and alert the doctor to any abnormalities.
• Call a doctor right away if the patient has trouble breathing, swelling of the face, lips, tongue, or throat, or hives.

DOBUTAMINE

Mechanism of action:

It is a dopamine analogue that is synthetic and an adrenergic stimulant (beta 1 > beta 2 > alpha). It is predominantly an adrenoceptor with actions on the heart that are more inotropic than chronotropic. It also has some beta 1 agonist effects, though not as much as dopamine. Beta 1 derenergic receptors are stimulated, but heart rate or peripheral blood vessels are only slightly impacted. It raises heart rate a little bit, but it also raises cardiac output.

Indication:

• Heart failure treatment in the short term
• Enlarged heart disease
• Support for infarction by inotopic
• Cardiovascular shock

Dose:

2.5 micrograms per kilogram per minute at first, and up to 10 micrograms per kilogram per minute as needed.

Contraindication:

• Bisulfites cause hypersensitivity in some people.
• Maximum dose: Occasionally up to 40 micrograms/kg/minute.

Side Effect

Headache, tremors, paresthesias, mild leg cramps, nervousness, fatigue, tachycardia, hypertension, (marked increased in systolic blood pressure), premature ventricular beats, palpitation, nausea, vomiting,leg cramps, tissue necrosis at the site of injection, nonspecific chest pain, shortness of breath. angina pectoris,

Nursing Consideration

• Body weight is used to calculate the infusion rate, which is then managed by an infusion pump or a microdrip IV infusion set.
• The duration of therapy and the rate of infusion are based on heart rate, blood pressure, ectopic activity, and urine output.
• Throughout the administration, continuously check your blood pressure, heart rate, ECG, pulmonary capillary wedge pressure, cardiac output, CVP, and urine output.
• Any major changes in vital signs, arrhythmias, or ECG should be reported to a doctor.
• During treatment, keep an eye on potassium levels since they can lead to hypokalemia. During prolonged therapy, check your electrolytes, BUN, creatinine, and prothrombin time once a week.