Which statement accurately describes Nitroglycerin paste dosing in the management of ACS?

• A. Nitroglycerin paste is a repeatable dose if CPAP is used.
• B. Sublingual nitroglycerin is not the preferred route for ACS.
• C. Nitroglycerin paste is never used in ACS.
• D. Nitroglycerin paste is a one-time dose.

Answer: (D)

Nitroglycerin paste dosing in ACS is about providing ongoing vasodilation, not a single administration. The paste is applied in a measured amount to a clean, dry area of skin and is typically re-applied at intervals (for example, every 4–6 hours) or adjusted per standing orders if chest pain persists. This repeatable dosing helps maintain a steady nitrate effect to relieve angina and prevent recurrent ischemia, while also requiring attention to tachyphylaxis and hypotension. Sublingual nitroglycerin remains the preferred route for rapid, initial relief of chest pain in ACS, with paste used for longer-term coverage or when SL/tablet routes aren’t feasible. Remember to monitor blood pressure and heart rate, rotate application sites to reduce irritation, and discontinue if hypotension or contraindications arise.