NITROGLYCERIN

Question 1

NITROGLYCERIN

Class?

Answer 1

• Anti-anginal agent/vascular dilating agent

Question 2

NITROGLYCERIN

Indications?

Answer 2

• Chest pain, anginal pain

Question 3

NITROGLYCERIN

Contraindications?

Answer 3

• Hypersensitivity
• Hypotension
• Pericardial tamponade
• Increased intra-cranial pressure
• Hypovolemia/severe anemia

Question 4

NITROGLYCERIN

Drug Interaction?

Answer 4

• Increased hypotension with beta-adrenergic blockers, antihypertensives, calcium channel blockers, and phenothiazines
• Tricyclic antidepressants and antihistamines may interefere with buccal absorption
• Can cause a lethal drop in blood pressure with patients taking ED medications

Question 5

NITROGLYCERIN

Administration?

Answer 5

• Adult: must be patient with own Nitro
• Sublingual: [0.3-0.4 mg] tablets. Repeat at 3-5 minutes as needed to a total of 3 tabs (with MCEP order)
• Lingual spray: [0.4 mg] metered dose, sprayed directly under tongue: additional one or two sprays every 3-5 mins for a total of 3 sprays.
• Pediatric: not recommended for pre-hospital use

Question 6

NITROGLYCERIN

Special Notes?

Answer 6

• Common side effects may include: throbbing headache, flushing, dizziness, and burning under the tongue (if these side effects are noted, the pills may be assumed potent, not outdated)
• Less common effect: marked hypotension, particulary orthostatic
• Generalized vasodilation may cause profound hypotension and reflex tachycardia
• NTG tablets lose potency easily and should be stored in a dark glass and in a dark room; NTG spray does not have this problem
• Use only with medical control on patients with systolic BP below 100 mmHg, HR > 60 or < 140