Nitroglycerin

Question 1

Nitroglycerin generic name

Answer 1

Nitroglycerin

Question 2

Nitroglycerin class

Answer 2

Vasodilator, organic nitrate, antianginal

Question 3

Nitroglycerin MOA

Answer 3

Smooth muscle relaxant acting on vascular, uterine, bronchial, and intestinal smooth muscle
• Reduces workload on the heart by causing blood pooling (decreased preload)
• Arteriolar vasodilation (decreased afterload)
• Coronary artery vasodilation
• Increases blood flow to myocardium
• Decreases myocardial O2 demand

Question 4

Nitroglycerin indications and field use

Answer 4

• Angina
• Myocardial infarction
• Congestive heart failure with pulmonary edema

Question 5

Nitroglycerin contraindications

Answer 5

• Hypovolemia
• Increased Intra cranial pressure
• Hypotension (relative)

Question 6

Nitroglycerin adverse reactions

Answer 6

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

Question 7

Nitroglycerin incompatibilities/drug interactions

Answer 7

Other vasodilators
Phosphodiesterase-5 inhibitors such as: Erectile dysfunction: Viagra, Cialis, Levitra
Pulmonary hypertension: Revatio (Sildenafil), Adcirca (Tadalafil), Staxyn ODT (Vardenafil).

Question 8

Nitroglycerin adult dosage

Answer 8

SL for Chest pain: 1/150 gr (0.4 mg) tablet or one full spray, may repeat x 3

SL for Pulmonary edema: 1-2 of the 1/150 gr (0.4 mg) tablets may be given SL every 5-10 minutes as long as the systolic BP is greater 90-100 systolic

IV infusion during interfacility transport must be given via infusion pump: Start at low range of 5 μg/min and increase in increments of 5 μg, monitoring pain and blood pressure until desired hemodynamic or clinical response is achieved (fall in SVR, relief of chest pain); most patients respond to 50-200 μg/min

Question 9

Nitroglycerin pediatric dosage

Answer 9

Not used

Question 10

Nitroglycerin routes of administration

Answer 10

IV or SL

IV infusion on interfacility transports; special training and infusion pump required

Question 11

Nitroglycerin onset of action

Answer 11

Seconds

Question 12

Nitroglycerin Peak Effects

Answer 12

5-10 minutes

Question 13

Nitroglycerin duration of action

Answer 13

1-10 minutes after IV discontinued

Question 14

Nitroglycerin AZ drug box minimum supply

Answer 14

1 bottle of tablets of 1 spray bottle

Question 15

Nitroglycerin special notes

Answer 15

• NTG is heat and light sensitive; stock rotation assures fresh supply.
• SL: Cautiously administer NTG to a patient who has never received it, consider
establishing an IV prior to administration.
• Patients with hypotension should be administered this drug with caution.
• Closely monitor vital signs, cardiac rhythm.
• Bradydysrhythmias and hypotension usually respond to Trendelenburg position; atropine
and vasopressors may be administered if needed.
• Monitoring IV nitroglycerin on patients during interfacility transport requires an infusion
pump and is limited to prehospital providers that have completed a special training curriculum in accordance with their medical control authorities.