Nitoglycerin

Question 1

Trade Name

Answer 1

Nitrostat, Nitro Spray, Tridil

Question 2

Class

Answer 2

Vasodilator

Question 3

Mechanism of action

Answer 3

Smooth muscle relaxant acting on vascular, uterine, bronchial, and intestinal smooth muscle,; reduces workload on the heart by causing blood pooling (depressed preload); arterial vasodilation 9 decreased after load); coronary artery vasodilation; increases blood flow to myocardium; decreases myocardial oxygen demand

Question 4

Indications

Answer 4

Acute coronary syndromes, acute MI, congestive heart failure with edema

Question 5

Contraindications

Answer 5

Hypovolemia, ICP, Bradycardia, SBP

Question 6

Adverse effects

Answer 6

Hypotension reflex tachycardia, bradycardia, decreased coronary perfusion at high doses (secondary to hypotension), headache secondary to dilation of the meningeal vessels.

Question 7

Incompatabilites/ Drug interactions

Answer 7

Other vasodilators; erectile dysfunction medications within the pst 48 hours

Question 8

Routes of administration

Answer 8

IV, SL spray

Question 9

Onset of Action

Answer 9

Onset in seconds peak of 5-10 min; duration of 15min

Question 10

Adult dose

Answer 10

one full spray is 0.4mg may report x3 provided SBP.140mmHg

Nitro drip titrate to effect

Question 11

Pediatric dose

Answer 11

Not indicated

Question 12

Special considerations

Answer 12

Caution in use on patients who have never used NTG; hypotension more commonly seen in the elderly
Brady-dysrhythmias and hypotension usually respond to shock position and fluids
Caution in patients presenting with an acute inferior MI; RVMI may be present affecting filling pressures; administer fluid bolus prior to admin of nitrates

Question 13

Protocols used

Answer 13

A-5: Chest pain
A-6: CHF
A-6b: CPAP