Nitropaste

[CapeCodMermaid, RN]

Do any of you still use Nitropaste for hypertension?

I haven't seen it used in years, but one of the docs here insists we use it PRN.

I seem to remember a valid reason its use was stopped years ago, other than it being messy and not very accurate to dose.

[Nascar nurse, ASN, RN]

We recently had a new admit come with orders for nitropaste. I hadn't seen it used in years either. The admitting nurse must not have liked the idea as she had the order changed before I could even suggest she do so.

Maybe a stupid question on my part but why not just use the patch PRN? At least you would have a more accurate dose. Kinda of reminds me of poking a procardia with a safety pin and giving PRN SL for HTN. Did you ever use that one? It actually worked pretty well for one past resident who's B/P would suddenly sky rocket without warning.

[CapeCodMermaid, RN]

We asked the doc to change to a patch, but he's too stubborn to change his mind. I've already reminded the new nurses to always wear gloves when putting the paste on. All it takes is one nitro headache to learn!

[amoLucia]

We asked the doc to change to a patch, but he's too stubborn to change his mind. I've already reminded the new nurses to always wear gloves when putting the paste on. All it takes is one nitro headache to learn!

Oh yeah.... learned the hard way!!!

[NurseKatie08, MSN]

I've seen it used on a rare occasion.

[SHGR, MSN, RN, CNS]

I work in outpatient clinic and look at patients' med lists all the time (if they call for refills, here for a BP visit, reconciling meds, etc). I don't remember seeing nitroglycerine paste on a med list.

BP meds do seem to have come and go- right now we seem to be giving everybody chlorthalidone these days; we give clonidine in the office PRN for high BP.

The thing with nitropaste (seems like we used it ALL the time 1990's med surg days- that, and SL nifedipine) is you can't apply it to the paper like the toothpaste in a toothpaste ad (round/3 dimensional); you have to apply it flat. It's not messy then when it is taped onto the patient.

[Esme12, ASN, BSN, RN]

The patch is more of a timed 24hr release and the paste is more of an immediate release. Depending on what part of the country is nitro-paste's popularity. If the MD is using it for an immediate RX for HTN the patch won't deliver the med quick enough. Nitro-paste fell out of favor for daily q 6hr use because of unpredictability of absorption with perks and valleys causing orthostatic hypotension and for causing severe episodic headaches due to the swings of absorption immediately after administration.....and the 24 hour release patches became reliable. It is used instead of SL nitro because it isn't as rapid of an onset and does last longer than Sl when treating the B/P prn.

For an acute episode of elevated B/P I have seen it used in the ED just like Procardia Sublingual (which has also fallen by the wayside in popularity) and Nimtopp for cerebral spasm/dilatation as another Ca channel blocker.

[turnforthenurse, MSN, NP]

We have some cardiologists who order it, but it really isn't that common from what I see. The patient will either be on a NTG drip or will have other medications to control their BP.

[eatmysoxRN, ASN, RN]

My previous place of employment utilized nitropaste on every chest pain patient. We weren't able to do nitro drips though, and if they needed that, they had to be transferred out. Now that I work on a cardiology floor, I see the paste infrequently. We use sl for CP, nitro drip when that fails. We don't use it for anything besides CP though since we usually have lopressor or vasotec PRN HTN.