Introduction
Knowing the pharmacokinetic effects of drugs is one of the advanced practice nurse’s responsibilities. As a significant branch of pharmacology, pharmacokinetics aims at describing and analyzing the conditions under which the body processes drugs (Pandit et al., 2021). Drug metabolism affects oral bioavailability, the way how a medication penetrates systemic circulation and accesses the action site (Alqahtani et al., 2021). Nitroglycerine, also known as glycerine trinitrate, is a vasodilatory drug that helps relieve anginal chest pain. The Food and Drug Administration (FDA) continues investigating its side effects and pharmacokinetics to learn appropriate routes of administration. Regarding its specific metabolic characteristics, nurses choose the sublingual route for nitroglycerine to make sure it is properly absorbed and works effectively. Understanding the drug’s characteristics allows for making the correct choice of administration routes and positively affects the bioavailability of nitroglycerine.
Pharmacokinetics of Nitroglycerine
Nitroglycerine is usually not given orally due to its extensive hepatic pre-systemic metabolism. It means that the concentration of the orally administrated drug is significantly reduced before it can reach the necessary circulation area. Nitroglycerine provokes the formation of free radical nitric oxide that activates chemicals in the blood for relaxing muscles and supporting vasodilation (Duckworth, 2020). Liver enzymes participate in nitroglycerine metabolism, while half-life is about 2-3 minutes. Oral administration is possible but not effective if immediate relief of angina is expected. A sublingual form of the chosen drug is quickly absorbed (from one to three minutes), and its effects may be observed within the next ten minutes and continue working for about 30 minutes. Nitroglycerine is discontinued when the desired outcome (drug effect on the body) is achieved.
In addition to a sublingual route of administration, other options may be utilized in nursing. Duckworth (2020) underlines the benefits of nitroglycerine sprays (0.3 mg), transdermal paste (0.2-0.6 mg/hr), patches (0.2-0.8 mg/hr), and intravenous solutions. If an intravenous administration set contains polyvinyl chloride, polyurethane, or polyolefin, plasma concentrations of nitroglycerine increase and reduce problems with blood pressure (Kim et al., 2018). When patients cannot accept the sublingual or oral administration because of physiological or personal reasons, nitroglycerine is delivered via a transdermal method, the absorption of which lasts about 5-10 minutes. To avoid further discomfort, it is recommended to use a surface with no hair.
Routes of administration have a specific impact on the bioavailability of the drug. According to Alqahtani et al. (2021), oral drug delivery is more effective than intramuscular or intravenous routes. In nitroglycerine’s case, the oral route has its shortages, and it is better to follow the sublingual standards to strengthen drug bioavailability. In their study, Alqahtani et al. (2021) admit that a fatty diet can also reduce the bioavailability of some drugs because the inhibition of intestinal uptake is changed. Surfactants demonstrate the improvement of bioavailability due to solubility and permeability mechanisms (Alqahtani et al., 2021). Nurses should be aware of these facts and connections to provide patients with the fastest and most effective treatment.
Conclusion
In general, nurses need to make multiple decisions affecting treatment quality, including pharmacokinetics awareness, medication prescription, and improved care quality. Nitroglycerine plays an important role in many treatment processes, and its metabolism and route of administration determine the effect duration. It is not enough to know a variety of routes of administration but to understand why a sublingual method is preferred over an oral one and apply this knowledge in nursing practice.
References
Alqahtani, M. S., Kazi, M., Alsenaidy, M. A., & Ahmad, M. Z. (2021). Advances in oral drug delivery. Frontiers in Pharmacology, 12. Web.
Duckworth, R. (2020). Nitroglycerin: Major actions and misconceptions. EMS1. Web.
Kim, C. O., Song, J., Min, J. Y., Park, S. J., Lee, H. M., & Byon, H. J. (2018). A comparison of the pharmacokinetic and pharmacodynamic properties of nitroglycerin according to the composition of the administration set: A preliminary study.Medicine, 97(9). Web.
Pandit, R., Gerrits, M. A., & Custers, E. J. (2021). Assessing knowledge of pharmacokinetics in an integrated medical curriculum.Medical Science Educator, 31(6), 1967-1973. Web.