Sublingual

Isoproterenol is given sublingually or by iv. It is metabolized by monoamine oxidase and catechol-0-methyltransferase in brain, Hver, and other adrenergically innervated organs. The pharmacological effects of isoproterenol are transient because of rapid inactivation and elimination. About 60% is excreted unchanged. Adverse effects using isoproterenol therapy include nervousness, hypotension, weakness, dizziness, headache, and tachycardia (86). 

Nifedipine (Table 3) is a potent vasodilator that selectively dilates resistance vessels and has fewer effects on venous vessels. It does not cause reflex tachycardia during chronic therapy. Nifedipine is one of the first-line choices for black or elderly patients and patients having concomitant angina pectoris, diabetes, or peripheral vascular diseases. Nifedipine, sublingually, is also suitable for the treatment of hypertensive emergencies. Nifedipine does not impair sexual function or worsen blood Hpid profile. The side effects are flushing, headache, and dizziness. 

Oral mucosal membranes provide a port for systemic therapy as weU. Nitroglycerin sublingual tablets (Nitrostat) abort acute mgina attacks methyl-testosterone [58-18-4] buccal tablets (Android 5) are indicated for testosterone [58-22-0] replacement therapy (39) md nicotine [54-11-5] gum (Nicorette) aids in smoking cessation. 

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. 

Promoting an Optimal Response to Therapy N URATES The nitrates may be administered by die sublingual (under die tongue), buccal (between the cheek and gum), oral, IV, or transdermal route Nitroglycerin may be administered by die sublingual, buccal, to peal, transdermal, oral, or IV route If die buccal form of nitroglycerin has been prescribed, die nurse instructs die patient to place die buccal tablet between die cheek and gum or between die upper lip and gum above die incisors and allow it to dissolve The nurse shows the patient how and where to place die tablet in die mouth. Absorption of sublingual and buccal forms is dependent on salivary secretion. Dry mouth decreases absorption. 

The dose of sublingual nitroglycerin may be repeated every 5 minutes until pain is relieved or until the patient has received three doses in a 15-minute period. One to two sprays of translingual nitroglycerin may be used to relieve angina, but no more than three metered doses are recommended within a 15-minute period. 

For patients who have difficulty swallowing dilti-azem, tablets can be crushed and mixed with food or liquids. However, the patient should swallow the sus-tained-released tablets whole and not chew or divide them. When nifedipine is ordered sublingually, the capsule is punctured with a sterile needle and the liquid squeezed under the tongue or in the buccal pouch. 

Take oral capsules or tablets (except sublingual) on an empty stomach unless the primary healdi care provider directs odierwise. 

Do not handle the tablets labeled as sublingual any more than necessary. 

Check the expiration date on die container of sublingual tablets. If the expiration date has passed, do not use die tablets. Instead, purchase a new supply. Unused tablets should be discarded 6 months after die original bottle is opened. 

When teaching a patient about prescribed sublingual nitroglycerin, tiie nurse informs tiie patient that if... 

Stevens-Johnson syndrome fever, cough, muscular aches and pains, headache, and lesions of the skin, mucous membranes, and eyes. The lesions appear as red wheals or blisters, often starting on die face, in the mo util, or on the lips, neck, and extremities, stomatitis inflammation of die mo util striae lines or bands elevated above or depressed below surrounding tissue, or differing in color or texture subjective data information supplied by the patient or family sublingual under die tongue... 

The initial dose of buprenorphine should be given at least 12-24 hours after the last heroin dose, 24 hours after the last methadone dose, or 48 hours after the last LAAM dose (see Table 2-3). The methadone dosage of methadone maintenance patients should be reduced to 30 mg/day before the transfer to buprenorphine is attempted. Ideally patients should show clear evidence of opiate withdrawal before receiving the first dose of buprenorphine, to avoid the risk that buprenorphine will precipitate more severe withdrawal. For the first day, sublingual buprenorphine/naloxone doses of 2/0.5-4/1 mg can be given every 2-4 hours, up to a maximum total dose of 8/2 mg/day. On the... 

Caille G, Spenard J, Lacasse Y, et al Pharmacokinetics of two lorazepam formulations, oral and sublingual, after multiple doses. Biopharm Drug Dispos 4 31—42, 1983... 

Greenblatt DJ, DivollM, Harmatz JS, et al Pharmacokinetic comparison of sublingual lorazepam with intravenous, intramuscular, and oral lorazepam. J Pharm Sci 71 248-252, 1982... 

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