Why is a patient who is using a transdermal nitroglycerin patch instructed to remove the patch at bedtime and apply a new one in the morning?

Nitroglycerin transdermal patches are used to prevent episodes of angina (chest pain) in people who have coronary artery disease (narrowing of the blood vessels that supply blood to the heart).Nitroglycerin is a vasodilator that works by relaxing the blood vessels so that the heart does not need to work as hard and therefore does not need as much oxygen.However, if nitroglycerin is used continuously, the body may develop tolerance to its effects, meaning that it will not work as well to prevent angina attacks.Therefore, it is important to remove the patch at bedtime and apply a new one in the morning, leaving a 10-12 hour nitrate-free interval.This way, the body can restore its sensitivity to nitroglycerin and avoid angina episodes during the day.

Choice A is wrong because allergic response is not a common reason to remove the patch at night.Although some people may experience skin irritation or rash from the patch, this is usually mild and does not require discontinuation of the medication.If the skin reaction is severe or bothersome, the patch can be applied to a different area of the skin or switched to another form of nitroglycerin.

Choice C is wrong because overdose is unlikely to occur from using the patch as prescribed.Nitroglycerin patches come in doses ranging from 0.1 milligrams per hour to 0.8 mg/hr, and should be placed on clean, dry, and hairless skin for 12-14 hours and removed for 10-12 hours.If a patch loosens or falls off, it should be replaced with a fresh one.Overdose symptoms may include severe headache, dizziness, blurred vision, nausea, vomiting, sweating, chest pain, fast or irregular heartbeat, difficulty breathing, fainting, or seizures.If these occur, the patch should be removed immediately and medical attention should be sought.

Choice D is wrong because management of BPH (benign prostatic hyperplasia) is not related to nitroglycerin use.

BPH is a condition

Taking niacin with an NSAID such as ibuprofen can reduce flushing, the most common adverse effect of niacin therapy. Flushing is a side effect of taking large doses of niacin (vitamin B3) supplements.It happens when the niacin causes the small blood vessels in your skin to dilate so more blood can rush through.Flushing can cause skin redness, warmth, itching, tingling, or burning sensations.

Choice A is wrong because taking niacin before starting daily activities can increase the risk of flushing and interfere with your routine.Flushing usually occurs within 15 to 30 minutes of taking niacin and lasts for about an hour.

Choice B is wrong because taking niacin with a sedative can increase the risk of liver damage, especially if the sedative is acetaminophen (Tylenol).Niacin can also cause liver problems at high doses, so combining it with another liver-toxic drug is not advisable.

Choice C is wrong because taking niacin with grapefruit juice can increase the risk of side effects, such as low blood pressure, dizziness, or fainting.Grapefruit juice can interfere with the metabolism of some drugs, including niacin, and make them more potent or toxic.

Normal ranges for niacin intake vary depending on age and gender.The recommended dietary allowance (RDA) for adult males is 16 mg per day and for adult females is 14 mg per day.Higher doses of niacin may be prescribed by a doctor to treat high cholesterol or other conditions, but they should be taken under medical supervision and with caution.