Alright. In this video, we are going to talk about some important vasodilators. If you are following
along with cards, I am on card number 19, which talks about nitroprusside, which is a vasodilator
that is used for a hypertensive crisis. The mode of action of this medication
is that it causes direct vasodilation of arteries and veins, so it brings that blood
pressure down very quickly. It reduces both preload and after load. So this medication,
like I said, it brings the blood pressure down very rapidly, so hypotension is going to be a
very important side effect for you to know. In fact, this particular medication does
carry a black box warning because it causes a dangerous drop in blood
pressure. So that's definitely a key side effect. A couple of other key side effects to keep in mind
are cyanide toxicity as well thiocyanate toxicity. So those aren't side effects that you see every
day. And in fact, I don't know another medication that has those. So those are unique side effects
that I would remember with nitroprusside. Other side effects can include
dizziness as well as GI upset. So we have one of our level of crew
members who provided a great tip for remembering this drug. So nitroprusside may "pruss" you into
the ground (or press you into the ground) when your blood pressure rapidly decreases.
So if your patient is getting nitroprusside and gets "prussed" into the ground,
then has severe hypotension, then you'll want to take some interventions based on your facility
policy. This can include raising the patient's legs, decreasing the dose of nitroprusside, and
increasing fluids. But again, you'll need to refer to your facility policy for those interventions.
Alright. Now let's talk about medications that are used to treat angina. The important
medications that I would be familiar with include nitroglycerin as well as
isosorbide mononitrate and isosorbide dinitrate. So these medications work to treat angina through
vasodilation. So they decrease the preload, and they also decrease myocardial oxygen demand.
The side effects of these antianginal medications are very important to know.
They include orthostatic hypotension as well as a headache and possible reflex tachycardia.
So the way that I remember these isosorbide medications cause a headache, is I think
about eating some icy sorbet, which kind of looks like isosorbide. And when you eat an icy sorbet,
it might give you a headache because it's so cold. And that helps me to
remember that isosorbide medications also can give you a headache as a side effect.
So, if your patient has sublingual nitroglycerin, then they need to keep this stored in a cool dark
place. If they have chest pain, they can take up to three tablets, right? So they would place one
under the tongue, wait five minutes. If they are still having chest pain, they need to call 911,
and then put a second one under the tongue, wait five minutes, and then if there's still no relief,
they can take a third, but no more than three. And then, if you are giving nitroglycerin
topically, you want to make sure you're wearing gloves so that you're
not absorbing the medication in your hands. And just in general, wear your gloves as
soon as you walk in the patient's room. It's just best practice.
And then, you want to remove the prior dose. So often, we apply this nitroglycerin on the
patient's chest. So you want to make sure you remove the prior dose. You want to make
sure you're rotating sites and you want to choose a clean, hairless area to place the
new dose. Right? So if the patient has a bunch of hair and you stick it on top of the hair,
it's not going to get absorbed. So you want to make sure you choose a hairless area.
Alright. In my next video, we will get into antidysrhythmic medications. If our free
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