nitroglycerin Flashcards
Classification
nitroglycerin
- antianginal
Nitrate
INDICATIONs
nitroglycerin
EMR
relief of chest pain suggestive of acute coronary syndrome
ACP
reduction of preload in acute cardiopulmonary edema
CONTRAINDICATIONs
nitroglycerin
SBP < 110mmHg
HR < 50 or > 150
- HYPERSENSITIVITY - other nitrates
- Viagra or Levitra use - past 24 hrs
- Cialis use - past 48 hrs
- hypotension // uncorrected hypovolemia
- severe anaemia
- constrictive pericarditis
- pericardial tamponade
- hx R-sided MI // 12 lead ECG
relative contra indication - open // closed angled glaucoma
Dosage - Adult
nitroglycerin
EMR
0.4mg spray SL - repeat q 3-5mins
- verify - BP ≥110 systolic + HR > 50 / < 150bpm
☎️ cliniCALL REQUIRED if no rx
Pharmacodynamics
nitroglycerin
- Relaxes vascular smooth muscle - predominantly a venodilator; also produces coronary and systemic arterial vasodilation to a lesser extent
- Decreases preload, decreases MVO2 (myocardial oxygen consumption)
Pharmacodynamic (c-GMP)
nitroglycerin
- nitroglycerin releases nitric oxide in vascular endothelial cells. Nitric oxide (NO) is a gas, which when released in the vascular smooth muscle, results in the formation of cyclic guanosine monophosphate (cyclic GMP)
- c-GMP relaxes vascular smooth muscle by inactivating myosin light-chain kinase or by stimulating dephosphorelation of myosin phosphate
Pharmacokinetics
nitroglycerin
SL
onset - 30s-2mins
peak - 5-10mins
half-life - 1-4mins
duration - 15-30mins
ADVERSE EFFECTs
nitroglycerin
- Hypotension
- Nausea
- Headache
Warning // Precautions
nitroglycerin
@RISK pts w/
- hx hepatic or renal insufficiency
- rx anti-hypertensives
- clinically significant aortic stenosis
- documented inferior ischemia w/ 12-lead ECG
DRUG INTERACTIONs
nitroglycerin
- ETOH may have additive vasodilatory effects that may lead to hypotension
- may act synergestically w/ anti-hypertensives
Special Notes
nitroglycerin
- For infusion: Nitro is generally mixed in a glass bottle. IV bags are made of polyvinylchloride (PVC) which absorbs the drug and decreases the concentration
- In hospital, cardiac ischemic chest pain that does not respond to NTG SL and morphine IV, is treated with a NTG infusion (typical mix: 50 mg in 250 cc - started at 10-20 µg/min and titrated in 10 µg/min increments to relieve pain)
