AMYL NITRITE

AMYL NITRITE
(am'il)
Amyl Nitrite
Classifications: nitrate vasodilator; antidote;
Therapeutic: antidote
; nitrate vasodilator
Prototype: Nitroglycerin
Pregnancy Category: X

Availability

0.3 mL ampules

Action

Short-acting vasodilator and smooth muscle relaxant. It is converted to nitric oxide, which causes the vasodilation. Action in treatment of cyanide poisoning is based on ability of amyl nitrite to convert hemoglobin to methemoglobin, which forms a nontoxic complex with cyanide ion.

Therapeutic Effect

Effective for immediate treatment of cyanide poisoning.

Uses

As an adjunct antidote in the immediate treatment of cyanide poisoning. (Because of adverse effects, unpleasant odor, and expense, infrequently used to treat angina pectoris.)

Unlabeled Uses

Change intensity of heart murmurs.

Contraindications

Hypersensitivity to nitrites or nitrates; severe anemia; uncontrolled hyperthyroidism; acute alcoholism; pregnancy (category X).

Cautious Use

Elderly; recent increase in intracranial pressure; cerebral hemorrhage, head trauma; hypotension; glaucoma; recent MI; lactation, children.

Route & Dosage

Acute Angina
Adult: Inhalation 0.18–0.3 mL prn

Cyanide Poisoning
Adult/Child: Inhalation 0.3 mL perle crushed every minute and inhaled for 15–30 s until sodium nitrite infusion is ready

Administration

Inhalation
  • Crush ampule between fingers to prepare (amyl nitrite is available in 0.18 mL and 0.3 mL perles, which are thin, friable glass ampules enveloped with woven fabric cover).
  • Instruct patient to sit a while immediately after drug is administered.
  • Note: Amyl nitrite is volatile and highly flammable; when mixed with air or oxygen, it forms a mixture that can explode if ignited.
  • Store at 8°–15° C (46°–59° F), unless otherwise directed. Protect from light.

Adverse Effects (≥1%)

Body as a Whole: Transient flushing, weakness. CV: Orthostatic hypotension, palpitation, cardiovascular collapse, tachycardia. GI: Nausea, vomiting. Hematologic: Methemoglobinemia (large doses). CNS: Headache, dizziness, syncope. Respiratory: Respiratory depression.

Pharmacokinetics

Absorption: Rapidly from mucous membranes. Onset: 10–30 s. Duration: 3–5 min.

Nursing Implications

Assessment & Drug Effects

  • Monitor for S&S of syncope, due to a sudden drop in systolic BP, which sometimes follows drug inhalation, particularly in older adults.
  • Monitor vital signs until stable. Rapid pulse, which usually lasts for a brief period, is an expected response to the fall in BP produced by the drug.
  • Chart length of time required for pain to subside after administration of drug.
  • Note: Tolerance may develop with repeated use over prolonged periods.

Patient & Family Education

  • Note: Drug has a strongly fruity odor.
  • Go to the emergency room immediately or consult physician if no relief from angina is experienced after 3 doses 5 min apart.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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