Nitroglycerin (Nitrostat)

Question 1

Drug Classification

Answer 1

Vasodilator/Nitrate

Question 2

Mechanism of Action

Answer 2

Nitroglycerin is a pro-drug, which must be de-nitrated to form the active metabolite nitric oxide (NO). Then, NO activates the conversion of GTP ->cGMP+2Pi in VSMC. cGMP activates a cascade of reactions that cause a reduction in intracellular Ca2+ ->VSMC relaxation (in arterioles) and decreased cardiac preload and after load.

Question 3

Pharmacokinetics

• Onset of Action
• Peak Effects
• Duration of Effects
• Half Life

Answer 3

• Onset of Action- 1-2minutes IV, 1-3minutes SL, 30 minutes topical
• Peak Effects- 5-10minutes SL, varies topical
• Duration of Effects- 20-30minutes SL, 3-6hours topical
• Half Life- 1-4 minutes

Question 4

Indications/Field Use

Answer 4

• Chest Pain associated with angina or MI

- Acute Pulmonary Edema/CHF

Question 5

Contraindications

Answer 5

• Shock/Hypotension
• Increased ICP
• Children under 12
• ED drugs within 48 hours

Question 6

Side Effects/Adverse Reactions

Answer 6

HA, dizziness, tachycardia, hypotension, rash, dry mouth, N&V

Question 7

Dose

Answer 7

Adult:
Spray- 0.4mg SL q3-5 minutes until effect achieved or b/p drops (max 3x25min)
Paste- 1/2-1 inch topical
Tablet- 0.4mg SL q3-5 minutes until effect achieved or b/p drop (max 3x25min)

Question 8

Precautions

Answer 8

• Expect HA from cerebral vasodilation
• Routine use may cause tolerance
• 12 lead ECG prior to administration - use extreme caution if R side MI

Question 9

Drug-Drug interactions

Answer 9

Orthostatic(dizzy when standing) hypotension with B blockers, severe hypotension with alcohol