The patient is receiving nitroglycerin 55 mcg/min.

Available: Nitroglycerin in 5% Dextrose Injection 25 mg per 250 mL (100 mcg/mL)

What is the flow rate?

A) Transdermal patch:
Transdermal patches are designed for slow, continuous delivery of medication through the skin over a long period of time, typically 24 hours. Although they provide steady medication levels, they do not offer a rapid onset of action. This route is more suitable for long-term control of conditions like angina but is not the fastest for immediate relief.

B) Topical ointment:
Topical ointments are applied to the skin and absorb slowly. While they may have local effects, they are not used for quick systemic effects. In the case of nitroglycerin, topical ointments are generally used for sustained release over several hours and are not intended for immediate relief of chest pain.

C) Suspended release:
Suspended release formulations are designed to release the drug slowly over time. Like transdermal patches, these formulations are meant for long-term management, not for rapid onset. A suspended release formulation of nitroglycerin would not provide the immediate relief that is typically needed in cases of acute angina or chest pain.

D) Sublingual:
The sublingual route provides the most rapid onset of action for nitroglycerin. When nitroglycerin is placed under the tongue, it is absorbed directly into the bloodstream through the mucous membranes of the mouth. This bypasses the digestive system and the liver (first-pass metabolism), allowing the drug to take effect quickly—usually within 1 to 3 minutes—making it ideal for acute relief of chest pain or angina. This route is commonly used for emergencies when rapid relief is needed.

A) Distribution:. Distribution refers to the process by which a drug is transported throughout the body after it is absorbed into the bloodstream. It involves the movement of the drug to various tissues and organs, where it can exert its effects. Factors such as blood flow, tissue permeability, and protein binding affect distribution.

B) Metabolism:
Metabolism refers to the biochemical process by which the body breaks down drugs into metabolites, usually in the liver. Metabolism can transform drugs into more easily excreted forms and sometimes alters the drug’s activity. It is essential for drug clearance and can affect drug efficacy and toxicity.

C) Absorption:
Absorption is the first step in pharmacokinetics, where the drug enters the bloodstream after being administered. It occurs primarily in the gastrointestinal (GI) tract for oral medications but can also happen in other routes like subcutaneous or intramuscular injections. The rate and extent of absorption are influenced by factors such as drug formulation, route of administration, and presence of food.

D) Synthesis:
Synthesis refers to the process of creating substances, such as drugs or other compounds, typically within the body or in a laboratory setting. While drug synthesis is crucial in drug development, it is not a step involved in the movement or processing of drugs within the body (which is what pharmacokinetics describes). Pharmacokinetics focuses on how the body handles drugs, not how they are created.