In order to prevent the development of tolerance, the nurse instructs the patient to:
A. Apply the nitroglycerin patch every other day.
B. Switch to sublingual nitroglycerin when the patient’s systolic blood pressure elevates to >140 mm Hg.
C. Apply the nitroglycerin patch for 14 hours each and remove for 10 hours at night.
D. Use the nitroglycerin patch for acute episodes of angina only.
Correct Answer: C. Apply the nitroglycerin patch for 14 hours each and remove for 10 hours at night
Tolerance can be prevented by maintaining an 8- to 12-hour nitrate-free period each day. Intermittent transdermal nitroglycerin therapy is effective in the treatment of stable angina and prevents the development of tolerance. Previous investigations have suggested that removal of nitroglycerin patches may be associated with a decrease in anginal threshold.
Option A: In patients with stable angina pectoris, intermittent transdermal nitroglycerin therapy is associated with a decrease in anginal threshold for 4 to 6 hours after patch removal. Although the cause of this phenomenon remains uncertain, it may be due to counterregulatory responses that develop during nitroglycerin patch application.
Option B: It is given in hospitals as well as prescribed for outpatient use. 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.
Option D: Continuous treatment with transdermal nitroglycerin leads to tolerance development within the first day of application. Effective long-term therapy can be provided by interval treatment with nightly patch removal, but even during the hours of intermittent patch application there is rapid attenuation of initial effects.
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