Case Study: GTN Mechanism and Function, Side Effects, Sub-lingual GTN Spray Administration

This case study explores the mechanism and function of GTN, its side effects, and the administration of sub-lingual GTN spray for chest pain relief. It also discusses the information that should be provided to patients like Mr. Carl Shapiro.

Case Study

Table of Contents
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................1
GTN Mechanism and Function....................................................................................................1
Side Effects of GTN.....................................................................................................................2
Method to use Sub-lingual GTN Spray and its Administration...................................................2
Information Provided to Carl Shapiro..........................................................................................2
CONCLUSION................................................................................................................................3
REFERENCES................................................................................................................................4

INTRODUCTION
Cardiovascular is considered as a heart condition that includes diseased vessels,
problems related to structure of heart and blood vessels and blood clots. This report is about a
case study in which a 54 year old man who presented to coronary care unit and complaining of
symptoms that are related to cardiovascular disease. The actions of GTN are provided in study
along with its side effects. The effectiveness of sub-lingual spray will be explained with
administration.
CASE STUDY I
Question 1
GTN Mechanism and Function
Nitroglycerin which is also known as Glyceryl Trinitrate is a medicine that is used for
heart failure, high blood pressure, painful periods, anal fissures and reduce the pain in chest due
to less blood flow to the heart. This medicine also can be used for the pain of the heart attack.
There are different ways can be used to get relief in chest pain that is related to heart attack or
chest pain due to improper blood flow in heart.
GTN works in two different ways to provide relief to the patient form the chest and heart
attack pain. In the first process GTN relaxes the blood vessels in body and causing them wide.
This reduces the strain in heart which is helpful for heart to pump blood in body. In other type it
also relaxes and widens the blood vessels in heart that increases blood flow in heart muscles.
This is how it provides relief to the patient in extreme chest pain due to poor blood flow and
heart failure (Munro, Jansen-Olesen and Olesen, 2017). The main action of the Gtn in body is to
reduce the pulmonary vascular resistance. Glyceryl trinitrate is also known as a vasodilation
agent. It is principle of pharmacological action that relaxes the vascular smooth muscle. The
oxygen carrying capacity can be reduced by several conditions. In first process it reduces the
concentration of red blood cells or decrease the saturation of the haemoglobin. This reduced
saturation of haemoglobin is decreased by GTN that reduce the demand of Cardiac muscle for
oxygen.
In the administration of GTN a 500 microgram medicine should be taken to get rid of
pain and if pain do not resolve so repetitive doses can be taken in interval of five minutes for
total three doses. If after this pain do not resolves it is suggested to call emergency services
immediately. This is how three continuous doses can be taken in interval of 5 minutes for each
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dose as chest pain starts (McGavock, 2017). There are different ways can be used to get rid of
pain which are- GTN spray, sub-lingual tablets, patches and ointment. This all are types of GTN
doses. GTN spray and sub-lingual tablets need to be placed under the tongue as pain develops.
The patches can be applied to chest or upper arm. The ointment can be applied on the chest to get
faster relief. This is how GTN can be administrate to a patients.
Question 2
Side Effects of GTN
Some of the main side effects of GTN are- Headache, flushing or redness in skin,
dizziness, weakness or fainting, rapid heartbeat, nausea or vomiting. Headache is common side
effect of GTN. It also can cause dizziness or weakness due to less oxygen demand in heart. This
dizziness is more common when a person try to get up from lying down or sitting down position.
There are some other side effects of GTN which are- difficulty in breathing which is rear
condition. Swelling of eyes, years and inside the nose. In sever and rare cases it can lead to coma
and seizures (Fromage, 2018). Fluctuation in heart beat is common cause of reduced demand of
oxygen in heart. Excessive sweating and flushing is also common side effect of GTN. In some
cases severe chest pain can be observed. Blurred vision and pale skin is also side effect of GTN.
The reason behind this side effect is less amount of oxygen in heart muscle.
Question 3
Method to use Sub-lingual GTN Spray and its Administration
As per the symptom Mr Carl Shapiro is suffering from angina that is also known as chest
pain. This spray is used to get relief in condition of chest pain. It is prescribed to the patient to
take two puffs of spray under the tongue as pain develops in chest. This spray helps the patient
by widen their veins to provide relief in chest pain. If pain continues after five minutes spray 2
more puffs under the tongue. If pain still not resolved then take aspirin if not allergic to it and
call emergency care. This is how the spray can be taken while sever chest pain develops. This
process of intake GTN is more effective than any other method because the spray of GTN is in
liquid form and it does not take much time in function (Webb, 2019). It provides instant relief
with in few minutes. So it is much better than sub-lingual tablet, patches or ointment.
Question 4
Information Provided to Carl Shapiro
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Mr Carl can be provided with different type of information related to the cardiovascular
disease, angina and medication for the issue. For the medication management they can be
provided with the administration of medication in which detail information of medication should
be provided. Mr Carl should be provided with information about when and how the take
medicinal spray (Dülger, Sik and Aba, 2018). The intervals between doses also should be told to
him to prevent severe issue. Mr Carl also should be informed about amount and frequency of
doses. This is how proper information can help the patient to avoid angina.
Case Study II
Question 1
Function of Antihypertensive
This is known as class of drugs that is used for the patients of hypertension which is also
known as high blood pressure (Wright, Musini and Gill, 2018). It helps to prevent the
consequences of high blood pressure in patients.
Mechanism
The primary action of this drug is on systematic vascular resistance. Some drugs that fall
in this class produce vasodilation with interfering with sympathetic adrenergic vascular tone. In
other action it also can block the formation of angiotensin ii or vascular receptor of it to provide
relief to the patient.
Question 2
Adult oral Daily Dose of Amlodipine
For the initial level adult people are suggested to take 5 Mg ones a day, for the
maintenance dose people are suggested to take 5 to 10 mg a day. The maximum dose of
Amlodipine is 10 Mg a day.
People whoa are fragile are suggested to take 2.5 Mg a day on initial level to prevent
major side effects. The doses of medication should be adjusted as per the response of patient's
body. This test should be performed in each 15 days (Okada, Li and Seyedsayamdost, 2019).
This medication should be ytaken alone.
Question 3
Side Effects of Amlodipine
Some of the main Side effects of Amlodipine are-
1. Stomach Pain
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2. Dizziness
3. Nausea
4. Hot and warm feeling in skin
5. fluctuation in heart rate (Burnier, M., 2017).
Question 4
Abrupt Cessation
It is usually considered as without any immediate consequences it can be associated with
symptoms of increased hypertension, sympathetic activity, Morbid Ischemic Cardiovascular
event or death. This is how Abrupt cessation of this drug can be defined (Antonios, T., 2019).
CONCLUSION
This study is concluding information about cardiovascular disease that is based on the
case study of Mr Carl Shapiro who presented with chest pain in coronary care unit. The detailed
information of GTN action mechanism has been explained in report. The function of this drug
also has been understood in study. The side effects of GTN also has been studied in the report.
Process to intake sub-lingual spray also has been analysed in report along with information that
is need to ne provided to Mr Carl Shapiro.
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REFERENCES
Books and Journals
Dülger, Ö., Sik, B.A. and Aba, Y.A., 2018. A comparative randomized study on effect of
vaginally administered glyceryl trinitrate placebo on cervical ripening prior to induction of
labor in overdue pregnancies. Indian journal of pharmacology. 50(5). p.260.
Fromage, G., 2018. The use of GTN paste in impending necrosis following soft-tissue
augmentation. Journal of Aesthetic Nursing. 7(8). pp.412-416.
McGavock, H., 2017. How Drugs Work: Basic Pharmacology for Health Professionals. CRC
Press.
Munro, G., Jansen-Olesen, I. and Olesen, J., 2017. Animal models of pain and migraine in drug
discovery. Drug discovery today. 22(7). pp.1103-1111.
Webb, A.J., 2019. Effects of vasodilating medications on cerebral haemodynamics in health and
disease: systematic review and meta-analysis. Journal of hypertension. 37(6). p.1119.
Wright, J.M., Musini, V.M. and Gill, R., 2018. First‐line drugs for hypertension. Cochrane
Database of systematic reviews. (4).
Okada, B.K., Li, A. and Seyedsayamdost, M.R., 2019. Identification of the Hypertension Drug
Guanfacine as an Antivirulence Agent in Pseudomonas aeruginosa. ChemBioChem.
20(15). pp.2005-2011.
Burnier, M., 2017. Drug adherence in hypertension. Pharmacological research. 125. pp.142-149.
Antonios, T., 2019. 116 Antihypertensive drug concordance in patients with apparent resistant
hypertension: a tertiary hypertension referral centre experience.
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