Nitroglycerin

Question 0

Nitroglycerin

Action

Answer 0

•Produces vasodilation by relaxing systemic venous and arterial vessels
• decreasing preload and after load
• decreasing myocardial workload 
• decreasing myocardial O2 consumption
• dilates coronary arteries
• onset=SL 2 min, topical 30-60 min
Duration= SL 30-60 min Topical 24 hrs

Question 1

Nitroglycerin (ntg, nitro)

Class

Answer 1

Vasodilator

Question 2

Nitroglycerin

Indications

Answer 2

•Discomfort / pain ? Cardiac origin
(S-126)
• fluid overload with rales (s-131)
     -hemodialysis patients
• respiratory distress ( s-136)
     -respiratory distress? cHF cardiac orgin

Question 3

Nitroglycerin

Dosage / route

Answer 3

Adult only
If BP >= 100
.4mg SL, MR q3-5"
Topical ointment paste 1"
If BP < 100
.4mg SL BHO; MR BHPO

Adult only
If BP >= 100
Topical paste 1"
If both>= 100 but <100
.4mg SL BHO; MR BHPO

Question 4

Nitroglycerin

Contraindications

Answer 4

• patient who has taken a sexual enhancemt medication such as Viagra, coal is, Levites, within 48 hrs
• patients taking medication for pulmonary hypertension, usually sidle fail (trade names: re atop, flown, veletri)

Question 5

Nitroglycerin

Side effects

Answer 5

• Orthostatic hypotension (can be profound)
• Dizziness / syncope
• Temporary pulsating head ache
• Facial flushing

Question 6

Nitroglycerin

Special information

Answer 6

(Concentration: 1 metered spray or 1 tablet = 0.4mg; ointment / paste: 1 inch =15mg)

Question 7

Nitroglycerin 
Special info:
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Answer 7

1. Nitroglycerin is used for adults only
2. Headache and facial flushing due to slight and short acting increased ICP
3. Alcohol ingestion potentiates the hypotensive side effect
4. Orthostatic hypotension more commonly seen in patients taking beta blockers
5. Check patients BP before and after administration of each dose of ntg
6. Preparing the patient for administration:
   - start an iv of NS before or soon after first dose
   - place patient in supine position or if patient is sitting elevate legs
7. If using tablet place tablet under young and allow to disolve
8. If unable to spray under young, spray I side mouth is well absorbed
9. If patient becomes hypotensive lay patient supine and consider fluid bolus
10. Remove existing ntg patch prior to any use of ntg
11. Do not shake ntg spray
12. Avoid application of dermal ntg to areas that may be used for cardio version
13. Avoid irritated / broken skin and consider taping patch to prevent movement of paste
14. If patients chest pain is resolved / gone on medic arrival ( self medicated with own ntg) continue treatment with ointment and ASA.
15. Patients taking Viagra, cialis, levetra, or other sexual medications or taking similar meds for pulmonary hypertension (revatio, flolan, veletri) may have a fatal drop in BP of 50-60 mm hg. Suspect that patient is on these meds if they have unexplained LOC. Half-life of these meds is 4+ hours.