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amyl nitrite[am´il ni´trīt]
Pharmacologic class: Coronary vasodilator
Therapeutic class: Antianginal
Pregnancy risk category C
Relaxes vascular smooth muscle, thereby dilating large coronary vessels, decreasing systemic vascular resistance, reducing afterload, decreasing cardiac output, and relieving angina
Ampules: 0.3 ml
Indications and dosages
➣ Acute angina attack
Adults: 0.18 to 0.3 ml by inhalation, repeated in 3 to 5 minutes if needed
➣ Antidote for cyanide poisoning
Adults and children: 0.3 ml by inhalation for 15 to 30 seconds q 5 minutes until sodium nitrite infusion is available
• Hypersensitivity to drug
Use cautiously in:
• glaucoma, hypotension, hyperthyroidism, severe anemia, early myocardial infarction
• elderly patients
• pregnant or breastfeeding patients.
• Crush ampule and wave under patient's nose one to six times. If needed, repeat in 3 to 5 minutes.
CNS: headache, dizziness, weakness, syncope, restlessness
CV: orthostatic hypotension, flushing, palpitations, tachycardia
EENT: increased intraocular pressure
GI: nausea, vomiting, fecal incontinence
GU: urinary incontinence
Hematologic: hemolytic anemia, methemoglobinemia
Skin: cutaneous vasodilation, rash, pallor, facial and neck flushing
Drug-drug. Aspirin: increased amyl nitrite blood level and action
Calcium channel blockers: increased risk of symptomatic orthostatic hypotension
Sildenafil: increased risk of hypotension
Sympathomimetics: decreased antianginal effects, hypotension, tachycardia
Drug-behaviors. Alcohol use: severe hypotension, cardiovascular collapse
• Monitor vital signs. Stay alert for tachycardia and orthostatic hypotension.
• Assess for bowel and bladder incontinence.
• Monitor neurologic response. Watch closely for dizziness and syncope.
• Assess level of headache pain.
• In long-term therapy, monitor CBC.
• Teach patient to crush capsule and wave it under his nose until angina is relieved (usually after one to six inhalations).
• Tell patient that drug often causes dizziness, orthostatic hypotension, and syncope. Advise him to sit or lie down until these effects subside.
• Inform patient that drug often causes headache. Instruct him to follow prescriber's recommendations for pain relief.
• Tell patient that drug may cause fecal or urinary incontinence. Encourage him to use bathroom frequently to avoid accidents.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and behaviors mentioned above.