Nitrolingual

[gvandellen]

Spraying the drug on the tongue is still sublingual. Oral implies swallowing the drug.

[AZCEP]

Spraying the drug on the tongue is still sublingual. Oral implies swallowing the drug.

Where did you get that bit of information? You shouldn't go back to that source ever again.

http://medical-dictionary.thefreedictionary.com/sublingual

Sublingual is below/beneath the tongue. Buccal is between the gums and the cheek. Oral is the space on the superior side of the tongue up to the hard palate. Oral administration does not imply the substance is swallowed. That would be PO, or para-oral.

[Scaramedic]

Spraying the drug on the tongue is still sublingual. Oral implies swallowing the drug.

:banghead:

[chbare]

Wow..I..uhh... :dontknow:

Take care,

chbare.

[ccmedoc]

Spraying the drug on the tongue is still sublingual. Oral implies swallowing the drug.

Oral could be taken to mean transmucosal as well as enteral...anything in the mouth "implies" oral..not necessarily swallowing. That would be enteral..involving the esophagus, stomach, small and large intestine...you get the point.. :wink:

Never Argue With An Idiot.

He'll Drag You Down To His Level And

Then Beat You With Experience.

..nuff said :oops:

[gvandellen]

I don't want this to be an argument. I just want to know if people read the insert with the Nitrolingual spray that says it can be given under or over the tongue and if it was an reasonable alternative for EMS. If it works the same then the protocols need to be updated to adjust for spray to be given on the tongue. Has anybody given it on the tongue or read the insert?

[paramedicmike]

Dude, if, after reading this entire thread, with everything that's been presented to you, you still don't have an answer then there really is no hope that you ever will.

CCMedoc has it right. Time to let this thread die because it's just not going to go anywhere from here.

-be safe

[akroeze]

This thread can be productive... at least I think my question in my previous post is productive...

[Just Plain Ruff]

this has been a good discussion albeit a heated one which carried over into chat last night.

I'm sorry to burst everyone's bubbles but....... after

Looking at numerous sites last night almost every one of the manufacturers site as well as I believe the Merck manual site said that you give nitroglycerin Spray under the tongue or on the tongue.

If you follow the literature included in the package you will also find this route of admin (on the tongue)

The PDR site http://www.pdrhealth.com/drugs/rx/rx-mono....p;contentId=387 even says to spray it on the tongue or under the tongue.

So in all actuality this route that Gvandellens mentor was doing is NOT wrong.

We as providers know that the most appropriate route of administration is under the tongue but to tell him that he is plain wrong is also wrong.

is the rate of absorption faster sublingually - Yes

Is it wrong to spray it on the tongue - NO

There were other statements made that were suspect but again, the way his mentor was administering the spray was not wrong.

If you can find any product literature, product web sites, pharmacology web sites and the like that prove that Nitro spray MUST be given under the tongue and NEVER on the tongue then we can discuss it but you would be hard pressed to find that info.

But as always, follow your protocols or guidelines put out by your medical director. No product literature is going to save your butt from losing a lawsuit if you deviated from your established protocols.

[mrmeaner]

Just thinking out loud (well, through my fingers).

You have a patient who is severe CHF to the extreme and semi-conscious from being so hypoxic. You want to give them nitro and assuming they meet all the V/S parameters how do you do it if they aren't coherent enough to lift their tongue? Do you lift it for them?

Just curious cuz I'm not sure.

If they are that crapped out, would you still want to give nitro?