Nitroglycerin

Question 1

Nitroglycerin
Classification

Answer 1

Vasodilator
Nitrate

Question 2

Nitroglycerin
Mechanism of Action

Answer 2

-Nitro is a pro-drug which must be de-nitrated to form the active metabolite nitric oxide (NO). Then NO activates the conversion of GTP-cGMP+2Pi in vascular smooth muscle cells (VSMC). cGMP activates a cascade of reactions that asue a reduction in intracellular Ca, VSMC relaxation (in arterioles) and decreased cardiac preload and afterload.

Question 3

Nitroglycerin
Onset of Action

Answer 3

1-2 min IV, 1-3 min SL, 30 min Topical

Question 4

Nitroglycerin
Peak Effects

Answer 4

5-10 min SL, varies topical

Question 5

Nitroglycerin
Duration of Effect

Answer 5

20-30 min SL, 3-6 hrs topical

Question 6

Nitroglycerin
Half-life

Answer 6

1-4 min

Question 7

Nitroglycerin
Indications/Field Use

Answer 7

CP associated with angina or MI
Acute pulmonary edema/CHF

Question 8

Nitroglycerin
Contraindications

Answer 8

Shock/hypotension
Increased ICP
Children under 12
ED drugs w/in 48 hrs

Question 9

Nitroglycerin
Side Effects/Adverse Reactions

Answer 9

HA
Dizziness
Weakness
Tachycardia
Hypotension
Rash
Dry mouth
N/V

Question 10

Nitroglycerin
Adult Dose

Answer 10

-Spray 0.4mg SL q3-5min until pain decreases or BP 100 (max 3 doses)
-Paste 0.5-1 inch topical
-Tablet 0.4 mg SL q3-5min until pain decreases or BP 100 (max 3 doses)

Question 11

Nitroglycerin
Precautions

Answer 11

-Expect HA from cerebral vasodilation
-Routine use may cause tolerance
-12-lead ECG prior to administration (use extreme caution if R-sided MI)

Question 12

Nitroglycerin
Drug-drug Interactions

Answer 12

Orthostatic hypotension with b blockers, severe hypotension with alcohol