F - 4 - NTG

Question 1

Adult SL dose of NTG for suspected ACS

Answer 1

0.4 mg

Question 2

Indications of NTG in the adult patient.

Answer 2

• Suspected ischemic chest pain/ACS

- Decompensated congestive heart failure

Question 3

Explain MOA of NTG

Answer 3

• Nitroglycerin is metabolized to Nitric oxide (NO)
• NO produces vasodilation (1* in Venous circulation, though some arterial action)
• venodilation increases capacitance and decreases pre-load
  
  • reduces myocardial oxygen demand (Frank-Starling)
  • reduces pre-load

Question 4

What are the serious side effects of NTG administration?

Answer 4

• severe hypotension
• severe bradycardia (MOA?)
• syncope
• weakness
• nausea

Question 5

NTG administration should be avoided in _____ MI, unless ordered by medical control.

What leads would show STE in this MI?

Answer 5

Inferior wall

• II, III, aVF

Question 6

NTG should be avoided in phosphodiesterase inhibitor (PD-5) use in the prior _____ hours*.

Answer 6

38 hours

• Except Viagra (Sildenafil) in prior 24 hours

Question 7

Pulmonary HTN in women may be managed with _______.

Answer 7

Revatio (sildenafil - “female Viagra”)

• withhold NTG in these patients if Revatio taken in prior 24 hours