Nitroglycerin Spray

Question 0

Drug classification

Answer 0

Vasodilator

Question 1

Trade name

Answer 1

Nitrolingual

Question 2

Actions (4)

Answer 2

1. Dilates arterial and venous vessels resulting in Venous pooling
2. Reduces preload and afterload resulting in decreased myocardial workload and reduced oxygen demand
3. Dilates coronary vessels resulting in increased perfusion of the myocardium
4. Relieves coronary vasospasm

Question 3

Indications (2)

Answer 3

1. Chest pain of suspected myocardial origin – myocardial ischemia
2. Congestive heart failure/cardiogenic pulmonary edema

Question 4

Contraindication (5)

Answer 4

1. S/S of cerebral hemorrhage or increased ICP
2. Poor systemic perfusion = systolic BP < 90 mmHg
3. Severe bradycardia = < 50 bpm or tachycardia > 100 bpm
4. Right ventricular MI
5. Viagra (sildenafil citrate) or Levitra taken within the 24 hours or cialis (tadolafil) within 48 hours

Question 5

Adverse effects - cardiovascular (6)

Answer 5

Hypotension*
Bradycardia
Rebound hypertension*
Palpitations
Reflex tachycardia*
Postural syncope

Question 6

Adverse effects - gastrointestinal (2)

Answer 6

Nausea/vomiting

Dry mouth

Question 7

Adverse effects - neurological

Answer 7

Throbbing headache*
Dizziness/faintness*
Increased ICP
Confusion
Sublingual burning

Question 8

Adverse effects - other

Answer 8

Flushed skin

Sublingual burning*

Question 9

Administration - chest pain

Answer 9

1 spray (metered to 0.4 mg = 1/150th gain) SL or transmucosal

May repeat every 3-5 minutes x 2

Question 10

Administration - CHF/Pulmonary Edema

Answer 10

0. 4 mg SL or transmucosal (1 puff) if SBP is >_ 100
1. 8 mg SL or transmucosal (2 puffs) if SBP >_ 150
2. 2 mg SL or transmucosal (3 puffs) if SBP >_ 200

May repeat dose x 2

Question 11

Pediatrics

Answer 11

Not recommended

Question 12

Onset

Answer 12

1-3 minutes

Question 13

Duration

Answer 13

30-60 minutes

Question 14

Precaution

Monitor and record blood pressure before and within 5 min after administration of NTG

Do not administer if BP < 100 systolic

If so place patient in shock position

Answer 14

Rationale

Hypotension may result due to vasodilation or it may produce a synergistic hypotensive effect with alcohol, beta and calcium channel blockers, phenothiazine and non-nitrate vasodilators

If hypotension does not resolve, place patient in shock position and consider a fluid challenge if breath sounds are clear

Question 15

Precaution

Do not shake canister

Answer 15

Rationale

Will alter metered dose

Question 16

Precaution

Hold canister in upright position

Answer 16

Rationale

Will alter metered dose when held at an angle

Question 17

Precaution

Instruct patient not to inhale spray

Answer 17

Rationale

May alter absorption rate

Question 18

Precaution

Patient should be sitting for administration and able to lie supine afterwards

Answer 18

Rationale

Causes hypotension

Question 19

Precaution

Treat very slow or fast rhythms before treating pain

Answer 19

Rationale

Correcting dysrhythmias may decrease or eliminate pain

Question 20

How supplied

Answer 20

0. 4 mg per spray in 14.5 gm canister (200 doses)

0. 3-0.4 mg tablets

Question 21

806 - chest pain adult only

Answer 21

0.4 mg SL or transmucosal.

May repeat x 2 every 3-5 minutes if SBP remains above 100 mmHg

Question 22

806 - respiratory distress/crackles

Answer 22

SL or Transmucosal

SBP >_ 100 mmHg give 0.4 mg
SBP >_ 150 mmHg give 0.8 mg
SBP >_ 200 mmHg give 1.2 mg

May repeat x 2 based on repeat BP