Which of the following instructions should be included in the discharge teaching for a patient discharged with a transdermal nitroglycerin patch?
A. “Apply the patch to a non-hairy, non-fatty area of the upper torso or arms.”
B. “Apply the patch to the same site each day to maintain consistent drug absorption.”
C. “If you get a headache, remove the patch for 4 hours and then reapply.”
D. “If you get chest pain, apply a second patch right next to the first patch.”
Correct Answer: A. “Apply the patch to a non-hairy, non-fatty area of the upper torso or arms.”
A nitroglycerin patch should be applied to a non-hairy, non-fatty area for the best and most consistent absorption rates. Transdermal methods of nitroglycerin administration are also commonly administered in emergency rooms during acute angina attacks. It is a 2% ointment that is applied directly to the patient’s skin and allowed to absorb.
Option B: Sites should be rotated to prevent skin irritation. The ideal application is on a surface with minimal amounts of hair as it can inhibit absorption, and care is necessary to not apply repeatedly to the same area if multiple doses are required. Repeated application of the ointment to the same area can cause skin irritation and dermatitis.
Option C: The drug should be continued if headache occurs because tolerance will develop. Any testing does not currently monitor nitroglycerin levels as its half-life is approximately 2 to 3 minutes, and the drug undergoes rapid metabolism from the body.
Option D: Sublingual nitroglycerin should be used to treat chest pain. Patients may be prescribed nitroglycerin to take as prophylaxis for anginal chest pain prior to an event that may provoke anginal symptoms. They must be instructed to allow the nitroglycerin to dissolve in their mouth and allow their oral mucosa to absorb the drug.
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