A 56 year old female with PMH significant for HTN, DM, and hyperlipidemia presents to the ED with chest pain and tightness. While workup is pending, the ordering provider wishes to administer nitroglycerin and asks which dosage forms are available at your critical access hospital.
Which of the following dosage forms would be appropriate for nitroglycerin to be administered in our patient? Select all that apply.
A. Intravenous admixture
B. Sublingual tablet
C. Sublingual spray
D. Transdermal patch
E. Extended release capsules
Answer with rationale:
The correct answers are A, B, and C. All 5 answers are dosage forms for which nitroglycerin can be administered. Additionally there is an ointment that exists. A key counseling point with the ointment (sometimes referred to as paste) it that it should be applied with a glove to limit vasodilation to the person administrating the nitro.
However all 5 answers are not correct...Read the question carefully. My hunch is that a number of folks would potentially miss this question as they read it purely thinking it was a dosage form question. While that is an important piece, the question also asks which should be used for our patient with acute angina? This makes answer D (the patch) and E (extended release capsules) incorrect as this is used chronically to prevent angina symptoms.
One word in a question can change the whole question. Remember to read every word to not miss an important piece of the puzzle!
Expertise in dosage forms are an important part of a pharmacist's practice, no matter where you are serving. While many pharmaceuticals come in one dosage form (statins for example) many come in multiple dosage forms such as anti epileptic drugs (i.e. phenytoin), aspirin (tablets and rectal suppositories), acetaminophen (intravenous, multiple oral, rectal suppositories). This becomes important in situations such as when patients are NPO, require faster onset therapies, or have a gastric tube where a medication may not be able to be crushed.
Have a great weekend!