Misc Cardiac

Question 1

List five uses of nitroglycerin and state it’s primary use

Answer 1

Angina (primary), CHF, acute MI, pulmonary hypertension, hypertensive emergency

Question 2

Describe the mechanism of action of nitroglycerin

Answer 2

Nitroglycerin is converted to nitric oxide within vascular smooth muscle eventually resulting in vasodilation of venules and some arterioles

Question 3

List whether each of the following drugs affect afterload or preload: beta blockers, calcium channel blockers, ace inhibitors, diuretics, nitroglycerin

Answer 3

Beta blocker – Afterload
CCB– afterload 
ace inhibitor – afterload 
diuretics – preload 
nitroglycerin – preload

Question 4

How does nitroglycerin decrease the workload on the heart?

Answer 4

Decreased preload from decreased venous return, coronary vasodilation and increased blood flow to coronary arteries

Question 5

How is nitroglycerin dosed to avoid tolerance-induced inefficacy?

Answer 5

Requires 10 to 12 hour nitrate free interval for regeneration of sulfa hydryl groups

Question 6

How is nitroglycerin stored?

Answer 6

Stored in glass amber bottles (adheres to plastic, sunlight inactivates, twist off cap for easy open, loses potency after 6 to 12 months)

Question 7

How is nitroglycerin used in times of angina attacks?

Answer 7

Please tablet/spray under tongue, wait five minutes, if symptoms persist place additional tablet under tongue and go to ER

Question 8

List the six available forms of nitroglycerin

Answer 8

IV, tabs, aerosol spray, buccal tabs, ointment, transdermal patches

Question 9

How should transdermal patches be disposed of?

Answer 9

Fold in half before placing into trash

Question 10

What medication can nitroglycerin not be mixed with?

Answer 10

PDE–5 inhibitors (sildenafil, teldalafil used to treat erectile dysfunction) can cause severe hypotension when mixed with nitrates

Question 11

What are poppers?

Answer 11

Street drug made of liquid nitroglycerin that gives short buzz, often used during sex