Nitroglycerin

Question 1

Classification

Answer 1

Vasodilator/nitrate

Question 2

Mechanism of Action

Answer 2

• Vascular smooth muscle relaxant, thereby dilating peripheral arteries and veins
• Causes pooling of venous blood and decreased venous return to the heart, which decreases preload.
• Reduces left ventricular systolic wall function, decreasing afterload.
• Reduces cardiac work

Question 3

Indications

Answer 3

• Angina pectoris
• Ongoing ischemic chest discomfort
• Myocardial ischemia associated with cocaine intoxication

Question 4

Contraindications

Answer 4

• Known Sensitivity to Nitrates
• Children under 12
• Hypotension
• Severe bradycardia or tachycardia
• Increased ICP or intracranial bleeding
• Patients taking medications for ED
• Caution in closed/angle glaucoma and uncorrected hypovolemia

Question 5

Adverse Effects

Answer 5

• Headache, lightheadedness
• Hypotension
• Bradycardia, paradoxical
• Cardiovascular collapse

Question 6

Administration

Answer 6

• Adult
  
  • Sublingual Tablet or Spray: (.4 mg) at 5 minute intervals.
  • Ointment 2% topical (Nitro-Bid): Apply 1-2” of paste over the chest wall, cover with transparent wrap, secure with tape.
  • IV:
    
    • ​Bolus: 12.5-25 mcg
    • Infusion: 5-200 mcg/min, titrated to SIBP > 100. End points of dose titration include a drop in BP of 10%, relief of chest pain, return of ST segment to normal on a 12-lead ECG.
• Pediatric: Not indicated

PA CHF Protocol:

SIBP > 180 = 3 tablets or sprays

SIBP 140-180 = 2 tablets or sprays

SIBP 100-140 = 1 tablet or spray