Nitroglycerin

Question 1

Generic Name:

Answer 1

Nitroglycerin

Question 2

Trade Name:

Answer 2

NitroStat

Question 3

Supplied:

Answer 3

0.4mg tablets/metered dose spray

Question 4

Class:

Answer 4

Vasodilator, Organic Nitrate, Anti-anginal

Question 5

Mechanism of Action:

Answer 5

•  Smooth muscle relaxant acting on vascular, uterine, bronchial, and intestinal smooth muscle
•  Reduces workload on the heart by causing blood pooling (decreased preload)
•  Arteriolar vasodilation (decreased afterload)
•  Coronary artery vasodilation
•  Increases blood flow to myocardium
•  Decreases myocardial O2 demand

Question 6

Indications and Field Use:

Answer 6

• Angina
• Myocardial infarction
• Congestive heart failure with pulmonary edema

Question 7

Contraindications:

Answer 7

• Hypovolemia
• Increased Intra cranial pressure
• Hypotension (relative)

Question 8

Adverse Reactions:

Answer 8

CV: Hypotension, reflex tachycardia, bradycardia, decreased coronary perfusion at high doses (secondary to hypotension), headache secondary to dilation of meningeal vessels.

Question 9

Incompatibilities/Drug Interactions:

Answer 9

• Other vasodilators
• Phosphodiesterase-5 inhibitors such as: Erectile dysfunction: Viagra, Cialis, Levitra
• Pulmonary Hypertension: Revatio (Sildenafil), Adcirca (Tadalafil), Staxyn ODT (Vardenafil)

Question 10

Adult Dosage: SL for Chest pain:

Answer 10

1/150 gr (0.4 mg) tablet or one full spray, may repeat x 3

Question 11

Adult Dosage: SL for Pulmonary edema:

Answer 11

1-2 of the 1/150 gr (0.4 mg) tablets may be given SL every 5-10 minutes as long as the systolic BP is greater 90-100 systolic

Question 12

Adult Dosage: IV infusion during interfacility transport must be given via infusion pump:

Answer 12

Start at low range of 5 μg/min and increase in increments of 5 μg, monitoring pain and blood pressure until desired hemodynamic or clinical response is achieved (fall in SVR, relief of chest pain); most patients respond to 50-200 μg/min

Question 13

Pediatric Dosage:

Answer 13

Not used

Question 14

Routes of Administration:

Answer 14

• IV or SL

- IV infusion on interfacility transports; special training and infusion pump required

Question 15

Onset of Action:

Answer 15

Seconds

Question 16

Peak Effects:

Answer 16

5 to 10 minutes

Question 17

Duration of Action:

Answer 17

1 to 10 minutes after IV discontinued

Question 18

Arizona Drug Box Minimum Supply:

Answer 18

1 bottle of tablets, or 1 spray bottle

Question 19

Special Notes:

Answer 19

•  NTG is heat and light sensitive; stock rotation assures fresh supply.
•  SL: Cautiously administer NTG to a patient who has never received it, consider establishing an IV prior to administration.
•  Patients with hypotension should be administered this drug with caution.
•  Closely monitor vital signs, cardiac rhythm.
•  Bradydysrhythmias and hypotension usually respond to Trendelenburg position; atropine and vasopressors may be administered if needed.
•  Monitoring IV nitroglycerin on patients during interfacility transport requires an infusion pump and is limited to prehospital providers that have completed a special training curriculum in accordance with their medical control authorities.