Nitrolingual

[gvandellen]

I was reading Street Watch: Notes of a Paramedic the other day as usual he had me laughing my A$$ off about getting people to lift their tongue up to spray Nitrolingual however my mentor said that you just spray it in the mouth on the tongue. I hadn't thought about it since he just told me last week but I mentioned this on the blog and sure enough PC found it to be true. Has anyone else heard about this?

[Dustdevil]

The proper route of administration for Nitrolingual is -- and has always been -- sublingual. You can and will get some effect from spraying it on the palatine surface of the tongue, but that is not the ideal or recommended route. When you spray it sublingual, all of the dose is caught in a pocket of well vascularised mucosa. When you spray it on top of the tongue, a large amount of the dose either ricochets off of, or completely misses the tongue to begin with, ending up in the oropharynx, oesophagus, and even into the lungs, none of which are particularly good things, the attenuated dosage notwithstanding. It's kind of like drinking a beer, but spilling two-thirds of it down your face. It's likely to take a lot more beer to get the desired effect that way. Same thing if you spray NTG on top of the tongue instead of under it.

I wonder if your mentor has ever wondered why not many of his patients are getting much relief from his supralingual NTG sprays. If he's smart enough to learn from this, and start doing it correctly, he may be surprised by how often NTG actually results in significant relief without having to max out on doses.

[gvandellen]

I wonder if your mentor has ever wondered why not many of his patients are getting much relief from his supralingual NTG sprays. If he's smart enough to learn from this, and start doing it correctly, he may be surprised by how often NTG actually results in significant relief without having to max out on doses.

Wow, a bold statement to insult a 20 year medic that you don't even know...We have a fantastic medical director that even went to the state and asked for our medics to bypass contact medical command boxes because we can actually think as healthcare providers and to only contact them if a treatment isn't working. Can your system say the same? Our medics were taught this from the medical director with information also obtained from the AHA so apparently the patients are getting relief.

Look at the package insert on the product Dust and it says...

"...spray onto or under the tongue."

and

..."preferably onto or under the tongue."

See

http://www.drugs.com/pro/nitrolingual.html

Either way IS the proper route of administration...

Buccal mucosa is just as absorbent and the only reason we put the Nitro tabs under the tongue is it stimulates saliva production to spread the Nitro around the mouth which the spray doesn't need.

[Ridryder 911]

Administration 101 for NTG. Remember, it is the mucosa membrane that allows the entry of the medication. The tongue (especially the ant. aspect) is a muscle and is not covered with the membrane. Hence, as Dust described probably bounces off the tongue and to be absorbed into the membrane.

Now back to your Googling or if one wants real information attempt to read the basics of medication administration, oh you failed to discuss the other route that is not discussed "rectal". Don't recommend it but could be done, if one is persistent.

R/r 911

[gvandellen]

Just where is the nitro going to bounce off to??? I've never seen mist bounce? Ridryder buccal administration is a proper route for drugs. Nicotine gum is made like this. Chew and stick back in cheek every minute. Might be time to go back to school.

[akroeze]

I'd like to step in here and suggest that everyone steps back and takes a few deep breaths. Let's not get personal here folks.

[Dustdevil]

Wow, a bold statement to insult a 20 year medic that you don't even know.

Yeah, that kind of confidence comes from thirty-five years of practice (probably before your mentor was out of diapers), including degrees in nursing and biology. Twenty years of practice means nothing if it was not quality practice, supported by in depth education. Building houses for twenty years doesn't make you an engineer. And following a protocol book for twenty years doesn't mean you know anything about pharmacophysiology. It just means you probably know how to read. Either his (and your) education sucked, or you both suck at remembering what you were taught. This is a no-brainer for somebody with a solid education in human physiology and pharmacology. And by solid, I mean better than what they spoon feed you in a four to six month tech school class.

We have a fantastic medical director that even went to the state and asked for our medics to bypass contact medical command boxes because we can actually think as healthcare providers and to only contact them if a treatment isn't working.

Congratulations. You just proved your medical director wrong.

Can your system say the same?

Yes, since before you were born.

Our medics were taught this from the medical director with information also obtained from the AHA so apparently the patients are getting relief.

Bretylium came from the AHA too. That doesn't mean it works. Only a cookbook medic would even think so.

Look at the package insert on the product Dust and it says...

"...spray onto or under the tongue."

As Rid stated, you need to find a reputable and reliable scientific resource before you start presuming to lecture people. What you are quoting is a 'keep it simple' patient insert, written for the lowest common denominator of patient who might be reading it. Although apparently a lot of Pennsylvania medics would fall into that "lowest common denominator" category.

Either way IS the proper route of administration...

Did you even read my original post, or did you just fly off half cocked in defence of your poorly educated "mentor" without taking a moment to digest what I said? I said oral was not the ideal way. And if you had taken a semester of Anatomy & Physiology, you would have spent an entire two days studying the tongue and oral physiology. It's day one of the digestive system section. And you'd know that, in order for the maximum amount of dosage to be absorbed efficiently, you have to go sublingual. But hey, if you want to be a smartass and a lazy ass just to spite me, be my guest. Spray it in their ear, if you like.

You came here all excited about learning something new that you didn't know before. A couple of us confirm that knowledge for you, and all of a sudden you don't believe it anymore. WTF is that all about? Did you just come here looking for a fight, or what?

Buccal mucosa is just as absorbent and the only reason we put the Nitro tabs under the tongue is it stimulates saliva production to spread the Nitro around the mouth which the spray doesn't need.

Closed topic. This isn't even worth discussion if you are incapable of getting a clue. :roll:

[gvandellen]

Do you have a degree in A&P Dust? Do you know the absorption rates of buccal vs sublingual tissue? Is it different? The same? Does it matter it 3 to 5 minutes between doses? Maybe you give the spray under the tongue because your director doesn't know the difference, maybe he doesn't care? Have you asked him? This isn't supposed to be a pissing match? You've been a medic for 35 years? So what? Medicine changes daily! I only link to that website as a general guideline but the product package insert states it as well. I'm just passing on information from the manufacture that I found based on information during my instruction. The great Dust doesn't know all or we'd all be attending your lectures for standing room only.

The only thing you've confirmed is that what I learned was wrong by your statements not the ideal way. I've read them and you quote..

"The proper route of administration for Nitrolingual is -- and has always been -- sublingual. You can and will get some effect from spraying it on the palatine surface of the tongue, but that is not the ideal or recommended route."

Says who? You? Your protocols? Your A&P teacher you had 35 years ago? What does the tongue have to do with it? Did I even say it would be absorbed by the tongue?

[Dustdevil]

You came here all excited about learning something new that you didn't know before. A couple of us confirm that knowledge for you, and all of a sudden you don't believe it anymore. WTF is that all about? Did you just come here looking for a fight, or what?

Closed topic. This isn't even worth discussion if you are incapable of getting a clue. :roll:

Bottom line re-posted for emphasis.

[Scaramedic]

Basic anatomy.

Top of tongue, thick membrane covered with papillae, i.e. taste buds.

Not great for absorption of medications.

Bottom of tongue. Thin mebrane, full of major vessels.

Great for absorbing medications.

Nuff said.

Addendum. Secondary to prior post.

lingual

Pronunciation:

ˈliŋ-gwəl also ˈliŋ-gyə-wəl

Function:

adjective

Etymology:

Latin lingua

Date:

1650

1 a: of, relating to, or resembling the tongue b: lying near or next to the tongue; especially : relating to or being the surface of tooth next to the tongue c: produced by the tongue

In other words sublingual is by it's very name under the tongue. That is where the tongue thing comes from you just mentioned.