Which of the following represents the MOST appropriate method of assisting a patient with his or her prescribed nitroglycerin tablet or spray?

• A. Inhale the spray into the lungs.
• B. Administer the medication sublingually and allow it to dissolve or absorb.
• C. Administer it orally with water.
• D. Apply the medication to the skin.

Answer: (B)

Sublingual administration provides the fastest, most reliable relief for acute angina because the drug is absorbed directly through the mucous membranes under the tongue into the bloodstream, bypassing the digestive system and first-pass metabolism by the liver. When nitroglycerin is placed under the tongue and allowed to dissolve or absorb, its onset is rapid and predictable, which is crucial for pain relief during an episode.

Inhaling the spray into the lungs isn’t how nitroglycerin is designed to work and wouldn’t yield reliable absorption. Swallowing the tablet with water sends the medication into the stomach and then the liver, where partial inactivation occurs before it reaches systemic circulation, resulting in slower, less predictable effects. Applying nitroglycerin to the skin delivers the drug much more slowly and is typically used for prevention rather than immediate relief, not for an acute episode.

So the best approach for quick, effective relief is placing the nitroglycerin sublingually and allowing it to dissolve or absorb.