Nitroglycerin adverse effects

Isosorbide is rapidly absorbed and undergoes rapid first-pass metaboHsm by the Hver. The bioavaUabUity of the subHngual and chewable tablets is 59% and 22%, respectively, for the regular tablet. Isosorbide is metabolized to isosorbide-2-mononitrate and isosorbide-5-mononitrate, both of which have pharmacologic activity. The elimination half-Hves of subHngual and po isosorbide dinitrate ate 1 and 4 h, respectively. Those of the 2- and 5-mononitrate metaboHtes are 1.5—3.1 h and 4—5.6 h, respectively. The two metaboHtes prolong the elimination half-life of the dinitrate. Adverse effects with isosorbide are similar to those described for nitroglycerin (99). 

Erythrityl is readily absorbed from the GI tract. It undergoes extensive first-pass metaboHsm ia the Hver by glutathione organic nitrate reductase. Time to onset of effect is 5—10 min by subHngual adrninistration and 20—30 min when swallowed. The duration of effects for the two routes ate up to 3 and 6 h, respectively. Adverse effects are similar to those described for nitroglycerin (99). 

Control of exudation depends mainly on the suitable choice of the nitrocellulose used. Some lack of uniformity in this product is certainly desirable. This offers no serious difficulty, although it is necessary to ensure a constant watch on manufacturing processes to see that quality is maintained. In other gelatine explosives, particularly those containing ammonium nitrate, exudation can be induced by slow chemical reaction. The addition of alkalis, for example, can liberate ammonia which in turn can react with nitrocellulose and cause it to lose its power of binding nitroglycerine. Such effects are accelerated at high temperatures and under wet conditions and it is usual practice to test all explosives under such adverse conditions before they are put on the market. 

Adverse effects include postural hypotension with associated CNS symptoms, reflex tachycardia, headaches and flushing, and occasional nausea. Excessive hypotension may result in MI or stroke. Noncardiovascular adverse effects include rash (especially with transdermal nitroglycerin) and methemoglobinemia with high doses given for extended periods. 

A woman is prescribed a combination of drugs consisting of a nitroglycerin patch and a (3-blocker, such as propranolol, to treat her attacks of secondary angina. Which effect of propranolol would counteract an adverse effect of nitroglycerin ... 

The action of light. The opinion is expressed in the literature (e.g. Naotim [22]) that diffused daylight has no adverse effect on nitroglycerine. Nevertheless in plants manufacturing or using nitroglycerine the latter is protected from direct sunlight. 

Which one of the following adverse effects is associated with nitroglycerin ... 

Abrams J, Schroeder K, Raizada V. Potentially adverse effects of sublingual nitroglycerin during consumption of alcohol. J Am CoU Cardiol 1990 15 226A. 

Pharmacological interactions are adverse effects that occur due to combined pharmacological activities, leading to exaggerated pharmacological effects. An example of pharmacological interactions is serious, sometimes fatal drop in blood pressure due to coadministration of nitroglycerin and sildenafil.3... 

A limited 8-d dietary study using nitroglycerin was conducted using northern bobwhite (N = 150) in exposures ranging from 15.9 to 5620 ppm, including a control. No adverse effects were reported with exposures up to 5620 ppm, yet some decreases in body mass were noted. Therefore, the NOAEL was reported as 3160 ppm and the LOAEL at 5620 ppm [47],... 

Verapamil decreases the consumption of nitroglycerine, allowing lower doses to be used. This decreases the frequency of adverse effects (e.g., headache, dizziness). 

In advising Mr. Green about the adverse effects he may notice, you point out that nitroglycerin in moderate doses often produces certain symptoms. These toxicities result from all of the following EXCEPT... 

You are considering therapeutic options for a new patient who presents with severe hypertension and angina. In considering adverse effects, you note that an adverse effect which nitroglycerin, guanethidine, and ganglion blockers have in common is (A) Bradycardia... 

The nitrates are available in various forms (eg, sublingual, transmucosal, translingual spray, and inhalation). Some adverse reactions are a result of the metiiod of administration. For example, sublingual nitroglycerin may cause a local burning or tingling in the oral cavity. However, die patient must be aware that an absence of this effect does not indicate a decrease in the drug s potency. Contact dermatitis may occur from use of die transdermal delivery system. 

Continuous infusions of nitroglycerin should be initiated at a dose of 5 to 10 mcg/minute and increased every 5 to 10 minutes until symptomatic or hemodynamic improvement. Effective doses range from 35 to 200 mcg/minute. The most common adverse events reported are headache, dose-related hypotension, and tachycardia. A limitation to nitroglycerin s use is the development of tachyphylaxis, or tolerance to its effects,... 

In the United States, contaminant levels in drinking water are regulated under the Safe Drinking Water Act. The EPA regularly reviews these contaminants, and in 2008 they released a third draft Contaminant Candidate List for public review and comment [34], As part of the process to develop the list, the Agency evaluated pharmaceuticals and personal care products to identify those that had the potential to occur in drinking water provided by pubhc utilities. EPA considered 287 chemicals identified as pharmaceuticals and personal care products however, only one, nitroglycerin, was included on the draft list because most occurred at levels far below those currently associated with any adverse health effects, based on the best available human health effects data... 

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