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Adverse Reactions/Side Effects
CNS: headache, restlessness, dizziness, fainting, weakness. EENT: qintraocular
pressure. Resp: shortness of breath. CV: hypotension, tachycardia, flushing.
Derm: cyanosis of lips, fingernails, or palms (indicates methemoglobinemia). GI:
nausea. Hemat: HEMOLYTIC ANEMIA, METHEMOGLOBINEMIA.
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amyl nitrite (am-il nye-trite)
Classification
Therapeutic: antianginals, antidotes
Pharmacologic: nitrates
Pregnancy Category X
Interactions
Drug-Drug:qhypotension with antihypertensives or acute ingestion of alco-
Indications
hol. Decreases the effects of norepinephrine. Antianginal activity decreased by epinephrine, and phenylephrine.
Acute treatment of angina pectoris. Unlabeled Use: Acute management of cyanide
poisoning. Diagnosis of cardiac murmurs.
Route/Dosage
Action
Antianginal
Reduces systemic arterial pressure (reduces afterload). Forms methemoglobin,
which combines with cyanide, forming a nontoxic compound (cyanmethemoglobin). Therapeutic Effects: Relief of angina pectoris. Prevention of fatal outcome
in cyanide poisoning.
Intranasal, Inhaln (Adults): 1 ampule crushed and inhaled; may be repeated in
3– 5 min (1– 6 inhalations).
Cyanide Poisoning
Pharmacokinetics
Absorption: Amyl nitrite is well absorbed through nasal mucosa.
Distribution: Widely distributed.
Metabolism and Excretion: Combines to form methemoglobin.
Half-life: Unknown.
Inhaln (Adults and Children): Inhale for 15– 30 sec of each minute until sodium
nitrite infusion is prepared.
TIME/ACTION PROFILE (antianginal)
● Assess heart rate and BP before and periodically throughout therapy.
● Angina: Assess patient for location, duration, intensity, and cause of chest pains
NURSING IMPLICATIONS
Assessment
ROUTE
ONSET
PEAK
DURATION
Inhaln
30 sec
unknown
5–10 min
Contraindications/Precautions
Contraindicated in: Hypersensitivity; Patients taking sildenafil, tadalafil, or
vardenafil; Severe anemia; Cerebral hemorrhage; Glaucoma; Recent head trauma;
Pregnancy and lactation.
Use Cautiously in: Hypotension; Hypovolemia; Constrictive pericarditis or cardiac tamponade; Hyperthyroidism; Recent MI; Hypertrophic cardiomyopathy; Geriatric patients (increased risk of orthostatic hypotension).
⫽ Canadian drug name.
⫽ Genetic Implication.
before and after administration.
● Cyanide Poisoning: Determine source of cyanide and assess patient for signs of
cyanide poisoning (tachycardia, headache, drowsiness, hypotension, coma, convulsions).
● Heart Murmurs: Assess heart rate before and throughout administration.
Potential Nursing Diagnoses
Acute pain (Indications)
Risk for injury (Side Effects)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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Implementation
● Ampule is wrapped in woven, absorbent covering. Do not remove covering. Crush
ampule between fingers and hold to patient’s nostrils for inhalation. Patient
should be sitting during and immediately after administration. Wash hands after
using.
● Angina: Titrate dose according to patient’s response.
● Cyanide Poisoning: Begin treatment at the first sign of toxicity if cyanide exposure is known or strongly suspected. For adults or children— Inhale for 15– 30
sec of each minute until sodium nitrite infusion is available.
● Heart Murmurs: Amyl nitrite should be inhaled until reflex tachycardia begins;
then stopped immediately.
Patient/Family Teaching
● Caution patient to change positions slowly to minimize orthostatic hypotension.
● Angina: Instruct patient in correct technique for use of amyl nitrite ampules. Re●
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lief should occur within 1– 5 min. If pain is not relieved 5 min after one dose, the
patient or family member should call 911 immediately.
Instruct patient to remain seated or lying during and after administration to prevent dizziness.
Inform patient that headache is a common side effect.
Instruct patient to wash hands after using this medication.
Caution patient to avoid drinking alcohol or taking sildenafil, tadalafil, or vardenafil concurrently with amyl nitrite.
Amyl nitrite is flammable; instruct patient to avoid exposing to heat or flame (e.g.
cigarettes).
Instruct patient to store medication in cool place away from light.
Cyanide Poisoning: Explain purpose and procedure for therapy to patient.
Evaluation/Desired Outcomes
● Relief of angina pectoris.
● Relief of signs and symptoms of cyanide poisoning.
● Change in intensity of heart murmurs.
Why was this drug prescribed for your patient?
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