glyceryl trinitrate (GTN) (CARDIAC DRUG)

Question 1

what are the pharmacokinetics for gtn

Answer 1

Administration: Sublingual
Distribution: Plasma protein
Metabolism: Liver
Excretion: Urine

Question 2

what are the pharmacodynamics for gtn

Answer 2

This is a nitrate drug.

absorbed through the buccal route and causes vasodilation of the coronary arteries and systemic veins.
This reduces the peripheral resistance (meaning reduced preload, afterload bp and coronary spasm)

according to the jrcalc in simple terms, gtn is a potent vasodilator drug causing:
. dilation of coronary arteries and relief of coronary spasm
.dilation in systemic veins caused lower pre-load
. reduced bp

Question 3

what are the indications for gtn (UPDATED)

Answer 3

cardiac chest pain due to angina or mi, when bp is ABOVE 90mmHg

consider gtn for AHF (acute heart failure) with ischemia or uncontrolled hypertension

UPDATED (pt with suspected cocaine toxicity with chest pain)

Question 4

what are the contraindications for gtn

Answer 4

hypotension (systolic BELOW 90mmHg for angina or mi) OR (110mmHg for acute heart faliure)

hypovolaemia

head trauma

cerebral haemorrhage

unconscious pt

a known severe aortic/mitral stenosis

Viagra and other related drugs that have been taken within 24 hours due to hypotension may occuring

Question 5

what is the initial dosage for gtn in adults for angina or MI or AHF for WMAS

Answer 5

400-800 micrograms (mcg)

Question 6

what is the route of administration for gtn

which way does WMAS use

Answer 6

Sublingual (tablet or spray administered under the tongue with closed mouth)

Sublingual (the spray under the tongue)

Question 7

what is the max dose for gtn for adults, for acute heart faliure for WMAS

Answer 7

6 sprays (2.4 milligrams (mg)

Question 8

what are the adverse effects that can occur with gtn

Answer 8

headache
dizziness
hypotension

Question 9

how often should you check the pt after initial dosage

Answer 9

every 5 minutes

Question 10

how is gtn presented on the road (HINT there are 2 ways)
which way do we use in WMAS

Answer 10

sublingual spray- 400 micrograms (mcg) gtn per metered dose (WMAS way)

sublingual tablets- 300,500 or 600 micrograms (mcg) per tablet.

Question 11

what dosage is contained within 1 spray of gtn

Answer 11

400 micrograms (mcg)

Question 12

What are the cautions for gtn
(HINT- remember cross-contamination)

Answer 12

pt with suspected posterior mi or right ventricular infarction

ensure to wipe nozzle of the spray and do not let the nozzle come into contact with the pt to avoid cross-contamination