GTN

Question 1

GTN

Presentation

Answer 1

Spray bottle containing 200x atomised sprays

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Question 2

GTN
Use

(conditions/ Indications)

Answer 2

• Chest pain/discomfort of presumed cardiac origin not relieved by rest and reassurance with systolic BP > 90mmHg.
• Acute Cardiac Pulmonary Oedema with systolic BP >90mmHg.
• Autonomic Dysreflexia with systolic BP > 160mmHg.
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Question 3

GTN

Type

Answer 3

Nitrate.

Question 4

GTN
Dose

(inc repeats
Multiple conditions)

Answer 4

Cardiac Chest Pain
• 0.4mg (1 spray) sublingually.
• If pain persists after 5 minutes and BP maintained, consider further sprays of GTN at 5 minute intervals.
• Should the first 3 doses provide some relief but symptoms persist, continue with further doses at 5 minute intervals if no contra-indications.
Acute Cardiogenic Pulmonary Oedema
• 0.4mg (1 spray) sublingually.
• If BP maintained, consider further sprays of GTN at 5 minute intervals.
• Should the first 3 doses provide some relief but symptoms persist, continue with further doses at 5 minute intervals if no contra-indications.
Autonomic Dysreflexia
• 0.4mg (1 spray) sublingually.

Question 5

GTN

Actions

Answer 5

Nitrates cause the relaxation of vascular smooth muscle resulting in:
• Vasodilation
• Peripheral pooling and reduced venous return
• Reduced left ventricular and diastolic pressure (preload)
• Reduced systemic vascular resistance (afterload)
• Reduced myocardial energy and oxygen requirements
• Relaxes spasm of coronary arteries

Question 6

GTN

Contraindications

Answer 6

•	Hypersensitivity
•	Hypotension < 90mmHg
•	Medications used for erectile dysfunction within 24 hours (e.g. Sildenafil®, Vardenafil®)
Precautions / Notes
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Question 7

GTN

Adverse effects

Answer 7

•	Hypotension (rare)
•	Tachycardia
•	Flushing
•	Headache
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Question 8

GTN

Precautions

Answer 8

• Nitrates are an early intervention and should not be delayed until on the stretcher or inside the ambulance.
• Administer to the patient in a seated or semi-recumbent position.
• Do not shake GTN bottle prior to administration.
• Assess BP before every dose.
• Severe hypotension is an uncommon side effect.
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