Nitroglycerin

Question 1

Nitroglycerin Trade Name

Answer 1

Nitrostat, Nitro-Bid

Question 2

Nitroglycerin Classification

Answer 2

Medscape:
Nitrates, Angina

Question 3

Nitroglycerin Mechanism

Answer 3

Medscape:
* Organic nitrate which causes systemic venodilation, decreasing preload.
* Cellular mechanism: nitrate enters vascular smooth muscle and converted to nitric oxide (NO) leading to activation of cGMP & vasodilation
* Relaxes smooth muscle via dose-dependent dilation of arterial and venous beds to reduce both preload and afterload, and myocardial O2 demand.
* Also improves coronary collateral circulation. Lower BP, increase HR, occasional paradoxical bradycardia

Capital:
Rapid smooth muscle relaxation causing a decrease in vascular resistance and preload, thereby lowering cardiac workload and to a lesser extent, coronary vasodilation

Question 4

Nitroglycerin Onset of Action

Answer 4

Capital:
1-3 mins

Question 5

Nitroglycerin Duration of Action

Answer 5

Capital:
Up to 30mins

Question 6

Nitroglycerin Indications

Answer 6

CT Protocols:
Vasodilator used in the treatment of chest pain secondary to acute coronary syndrome (ACS) and CHF/Pulmonary edema

Question 7

Nitroglycerin Contraindications

Answer 7

Capital:
Hypotension, Hypovolemia, Right ventricular (RV) infarction, Erectile dysfunction medications (Cialis, Levitra, Viagra) taken in past 24-48 hours

Question 8

Nitroglycerin Side Effects/ Precautions/ Comments

Answer 8

Capital:
Hypotension, Reflex tachycardia, Syncope, Nausea/vomiting, Burning at absorption site, Dry mouth

Question 9

Nitroglycerin Adult Dose

Answer 9

CT Protocols:

Acute Coronary Syndrome
* Facilitate administration of the patient’s own nitroglycerin every 3-5 minutes while symptoms persist and systolic BP remains >100mmHg, to a total of 3 doses.
* 0.4 mg SL every 3 – 5 minutes while symptoms persist and if systolic BP remains >100 mmHg.
* 10 micrograms/minute if symptoms persist after 3rd SL nitroglycerin.
* Increase IV/IO nitroglycerin by 10 micrograms/minute every 5 minutes while symptoms persist and systolic remains >100 mmHg.
* If IV/IO nitroglycerin is not available, consider the application of nitroglycerin paste 1 – 2 inches transdermally.

Congestive Heart Failure
* Consider nitroglycerin 0.4 mg SL every 5 minutes while symptoms persist and if the systolic BP is >100 mmHg.
* IV/IO nitroglycerin 50 micrograms/minute, increase by 50 micrograms/minute every 3 – 5 minutes (it is recommended two (2) IV/IO lines should be in place).
* (Generally, accepted maximum dose: 400 micrograms/minute.) OR
* Nitroglycerin paste 1” – 2” transdermally

Question 10

Nitroglycerin Pediatric Dose

Answer 10

Capital: Not recommended

Question 11

Nitroglycerin
Max Dose Adult (Pediatric)

Answer 11

Generally, accepted maximum dose: 400 micrograms/minute

Question 12

Nitroglycerin Routes of Administration

Answer 12

IV/IO, SL, Transdermal Paste

Question 13

Nitroglycerin How Supplied

Answer 13

0.4 mg sprays and tablets; transdermal paste; 200mcg/ml glass vials for IV infusion