Nitroglycerin

Question 1

What classifications is Nitroglycerin under?

Answer 1

• Antianginal

- Nitrate

Question 2

Explain the pharmacodynamics of Nitroglycerin

Answer 2

• Relaxes vascular smooth muscle – predominantly a venodilator; also produces coronary and systemic arterial vasodilation to a lesser extent
• NTG releases nitric oxide in vascular endothelial cells. Nitric oxide is a gas, which when released in vascular smooth muscle, results in the formation of cyclic guanosine monophosphate (Cyclic GMP). c-GMP relaxes vascular smooth muscle by inactivating myosin light-chain kinase or by stimulating dephosphorelation of myosin phosphate.
• Decreases preload, decreases MVO2 (myocardial oxygen consumption)

Question 3

What is the onset timing for SL Nitroglycerin?

Answer 3

1-3 minutes

Question 4

What is the peak timing for SL Nitroglycerin?

Answer 4

Unknown

Question 5

What is the duration for SL Nitroglycerin?

Answer 5

30 minutes

Question 6

What is the half-life for SL Nitroglycerin?

Answer 6

1-4 minutes

Question 7

What are the indications for Nitroglycerin?

Answer 7

• Chest discomfort of suspected cardiac ischemic origin

- Cardiogenic acute pulmonary edema (APE)

Question 8

What are the contraindications for Nitroglycerin?

Answer 8

• Allergy or known hypersensitivity to nitroglycerin or other nitrates
• Viagra or Levitra use in the past 24 hours
• Cialis use in the past 48 hours
• Hypotension or uncorrected hypovolemia
• Severe anemia
• Constrictive pericarditis and pericardial tamponade
• Right Sided Myocardial Infarction on 12 lead ECG

Question 9

List the precautions for Nitroglycerin

Answer 9

• Use with caution in the presence of hepatic or renal insufficiency
• Patients on concurrent anti-hypertensive therapy
• Inferior Myocardial Infarction on 12 lead ECG

Question 10

List the adverse effects for Nitroglycerin

Answer 10

• Hypotension - Do not administer if SBP < 90 OR patient exhibits signs of significant hypo perfusion
• Nausea
• Headache

Question 11

What is the ADULT dosing for Nitroglycerin?

Answer 11

• 0.4 mg spray SL - repeat q 3-5 min. - maintaining B/P > 100 systolic

Question 12

What is the relative contraindication for Nitroglycerin?

Answer 12

Open or closed angle glaucoma