Nitroglycerin

Question 1

Indications (4 points) for nitroglycerin

Answer 1

❑ Initial antianginal for suspected ischemic chest pain
❑ For initial 24 – 48 hours in patient with AMI and CHF, large interior wall infarction, persistent or recurrent ischemia
❑ Continued use (beyond 48 hours) for patients with recurrent angina or persistent pulmonary congestion
❑ Hypertensive emergencies; Non-cyclic antidepressant overdose; stimulant overdose (Use IV infusion ONLY; no bolus required)

Question 2

nitroglycerin dosage

Answer 2

SL - 0.3 mg tab or 0.4 mg spray q 5 min prn; max of 3 doses

IV - Bolus 30 – 60 mcg (if no SL medication given); begin infusion at 10 mcg/min; titrate to effect; increase by 10 mcg/min q 3-5 min. Max dose of 200 mcg/min; Mix 25 mg/250 ml NS or D5W (100 mcg/ml)

Transdermal Patch – 0.2 – 0.8 mg/hr

Pediatric
0.5-1.0 mcg/kg/min IV/IO to a max of 10mcg/kg/min.

Question 3

Contraindications for nitroglycerin

Answer 3

❑ Right ventricular infarction (Sublingual Spray Administration- 0.3mg to 0.4 mg are too large a dose and will drop preload and significantly decrease cardiac output. This increases mortality rates in these patients)
❑ Hypersensitivity to nitrates
❑ Avoid use in extreme bradycardia (<50 bpm)
❑ Hypotension (<90 mmHg) or a drop of >30 mmHg below baseline (systolic BP)
❑ Uncorrected hypovolemia
❑ sildenafil (Viagra), vardenafil (Levitra) use within 24 hours or tadalafil (Cialis) within 48 hours