Drug Profiles: Nitroglycerine, Atropine sulfate

Question 1

Nitroglycerin: Side effects

Answer 1

Hypotension, headache, dizziness, dry mouth.

Question 1

Atropine Sulfate: Supplied

Answer 1

1mg/10ml preloaded syringe.

Question 2

Atropine Sulfate: Contraindications

Answer 2

None when used in emergency situations.

Question 3

Atropine Sulfate: Side effects

Answer 3

Acute psychosis, vasodialation, dehydration, elevated temperature, and mydriasis (pupil dialation). Hint: Mad as a hatter, hot as a hare, red as a beet, dry as a bone, and blind as a bat.

Question 4

Nitroglycerin: phamacokineics

Answer 4

Onset:1-2 minutes

Question 4

Atropine Sulfate: Precautions

Answer 4

Paradoxical bradycardia can occur after slow administration or with small doses (minimum dose 0.5mg adults. 0.1mg children). Avoid in hypothermic bradycardia.

Question 5

Atropine Sulfate: Indications

Answer 5

Symptomatic bradycardia, organophosphate poisoning, nerve agent poisoning. Atropine is considered ineffective for bradycardia associated with high-level AV blocks (2^nd degree type II and 3^rd degree). In these cases , consider pacing or dopamine first.

Question 6

Atropine Sulfate: Dosage

Answer 6

Bradycardia: 0.5-1mg every 3-5 minutes (max dose is 0.04mg/kg). Poisoning: 1-2mg initially, can be repeated every 5-60 minutes as needed.

Question 7

Atropine Sulfate: Mechanism of Action

Answer 7

Atropine is a competitive antagonist for acetylcholine at the muscarinic receptors on the target organs of the parasympathetic system (e.g. heart, lungs. salivary glands etc.). In this way, atropine blocks the action of the parasympathetic system.

Question 9

Atropine Sulfate: Pharmacokinetics

Answer 9

Onset: immediate

Question 10

Nitroglycerin: Precautions

Answer 10

Check vitals after each administraton, NTG induced hypotension responds well to supine positioning and fluids. It is preferable to establish IV access prior to adminstering NTG. Right-sided MI and use of NTG can result in sever hypotension

Question 11

Nitroglycerin: Note

Answer 11

Nitroglycerin paste is not indicated for the treatment of acute chest pain. some protocols will use paste in conjunction with sublingual doses.

Question 12

Nitroglycerine: Class

Answer 12

Nitrate

Question 14

Nitroglycerne: Mechanism of action

Answer 14

Causes vasodialation that reduces preload, reducing cardiac workload and myocardial oxygen demand. Dialates coronary arteries, resulting in improved perfusion to ischemic myocardium. Relief of ischemia alleviates chest pain.

Question 15

Nitroglycerin: Dosage

Answer 15

1 tablet (0.4 mg) given sublingually q 5 minutes. 1 metered dose spray (0.4mg) sublingually q 5 minutes. 1-2” of paste. 5mcg/min IV (titrate to 5mcg/min q 5 minutes untill desired effect is achieved.)

Question 16

Nitroglycerin: Indications

Answer 16

Chest pain thought to be cardiac in origin, acute pulmonary edema, may be used in hypertensive crisis.

Question 17

Nitroglycerin: Contraindications

Answer 17

Hypotension (generally systolic <100), recent use of erectile dysfunction medications (Viagra [sildenafil citrate] and Lavitra [vardenafil] within the last 24 hours, Cialis [tadalail] within the last 48 hours)

Question 18

Atropine Sulfate: Interactions

Answer 18

Additive anticholinergic effects with other anticholinergic compounds, including antihistamines,TCA’s.

Question 19

Atropine Sulfate: Class

Answer 19

Parasympathetic, anticholinergic, antimuscarinic, vagolytic