nitro

Nope. Nitro relaxes the vessels and causes blood pressure to lower as a result, hence why it's given in an MI (if you can relax the vessels, blood might be able to pass the blockage) and for angina (allows blood to flow back into the ischemic area).

If the BP is already low, Nitro could bottom someone out.

Thanks. I should add this was extended release too. I wasnt giving it bit i noticed in a pts hx it was when he was 97/58

I can't say no just because of a low BP. Did the pt take this medication regularly at home? Was his BP at his baseline or much lower? Did he take this med for chronic CP/angina?? Who ordered the medication, his cardiologist?? While the nitro can lower the BP, this might be what the PCP wants, so when in doubt call the MD.

I dont know all the details because i only had that pt for an hour so my colleuge could leave early and didnt give him a single med.. I think it was given for angina and i know people on nitro are on a strict schedulesometimes. So it seemed like a slippery slope. Havent said anything tho. And sorry everyone for my horrible writing im on my phone.

Even if it WAS an XR dose, I'd hesitate to give it without the OK from the prescribing physician. If his BP has been running low, that could be all he needs to bottom out.

I wouldn't hesitate to give it if it's not his first dose. If it was his first dose then some more investigation is warranted.

There is a big difference between someone who has a systolic in the 90's when they aren't on a drug that affects BP and you are about to give their first dose, and a patient who's systolic is in the 90's as a result of the last dose the patient took. In a patient already on a long acting Nitrate, their BP shouldn't react any different to each additional dose after a steady-state has been reached (usually after a couple of doses).

For patients on long acting Nitrates, 97 systolic really isn't low, that may be towards the upper end of their goal range depending on the severity of their cardiac function.

some patients need the after load reduction for their hearts.

I'm not an expert by any means on the issue, but would there not be a preload reduction as well? Dilate the veins--> reduce venous return--> reduce preload.

yes.....I neglected to add the "pre"/after load reduction"....my bad :)

That's okay...I wasn't trying for a "gotcha" moment...just wanted to make sure I wasn't off base (since the latter happens often enough).

My philosophy is that, when in doubt, call the physician for parameters or the OK to give or hold. Ultimately, we shouldn't withhold medication that was ordered without asking the doc.

Look at trends - especially how BP reacted to the last few doses given.