Pharmacological and Parenteral Therapies Q 70

Correct Answer: C. Headache

Because of its widespread vasodilating effects, nitroglycerin often produces side effects such as headache, hypotension, and dizziness. Headaches can be severe, throbbing, and persistent and may occur immediately after use. Vasodilation and venous pooling can increase the amount of blood in the cranial space, resulting in increased intracranial pressures; this can cause persistent, throbbing headaches, along with confusion, fever, vertigo, nausea, vomiting, and visual disturbances.

Option A: Nitroglycerin produces hypotension instead of hypertension due to its vasodilating effects. Many of these adverse effects are secondary to the hypotensive effects of nitroglycerin. Patients may report symptoms of orthostatic hypotension which manifest as dizziness, weakness, palpitations, and vertigo. Profound hypotension may occur in patients with preload-dependent conditions.

Option B: Stomach cramps are not a side effect of nitroglycerin. Some patients can be more sensitive to the hypotension caused by nitrates, which can result in nausea, vomiting, diaphoresis, pallor, and collapse even at therapeutic doses. Nitroglycerin is both a protein-bound drug, and it undergoes hepatic metabolism. Therefore it has numerous drug interactions. Before prescribing, providers should determine if the patient is taking any medications that may interact with nitroglycerin.

Option D: Difficulty of breathing is one of the side effects of nitroglycerin. In the event of overdose, monitoring of vital signs may be necessary to monitor the hemodynamic effects of nitroglycerin. Continuous monitoring of blood pressure, heart rate, respiratory rate, and oxygen saturation is recommended. As intracranial pressure increases, symptoms will progress to dyspnea secondary to a reduced respiratory effort, heart block, bradycardia, paralysis, seizures, coma, and, eventually, death.