Nitroglycerin (Nitro, NTG)

Question 1

Classification

Answer 1

• Antianginal
• Vasodilator

Question 2

Actions

Answer 2

• Reduces cardiac oxygen demand primarily by dilating blood vessels
• This results in decreased blood flow (preload) to heart from body, decreased resistance to hearts pumping (after load)
• Dilation of coronary arteries results in increased blood flow to cardiac tissue

Question 3

Indications

Answer 3

• For cardiac & chest pain
• If PT is prescribed Nitro, the systolic BP must remain >= 110 mmHg
• If PT does not have prescription for Nitro, but appears to be having cardiac type chest pain w/ a SBP >110 mmHg, HR>150, call EPOS for Nitro administration orders

Question 4

Contraindications - Functional Inquiry

Answer 4

1. Erectile Dysfunction Drugs
   - Ask PT if they have taken Viagra/Levitra in 24 hrs or Cialis w/in 48 hrs
2. Allergy/Hypersensitivity to Nitrates
   - Ask PT if they have had adverse reaction to Nitrates in the past
3. Prescription
   - Ask if PT is prescribed NTG
   - If not prescribed, call EPOS as per protocol

Question 5

Contraindications - Physical Assessment

Answer 5

1. Blood Pressure
   - Assess blood pressure prior to each dose of NTG
   - Systolic >= 110

Question 6

Cautions - Functional Inquiry

Answer 6

1. Hypotension
   - Be aware that this may cause Hypotension in PT after administration

Question 7

Cautions - Physical Assessment

Answer 7

• Make sure your PT is seated & at no risk of fall if they may become hypotensive

Question 8

Side Effects

Answer 8

• CVS: Hypotension
• CNS: Dizziness, weakness, headache
• GI: Nausea, vomiting

Question 9

Dosage

Answer 9

Q3 mins maintaining systolic BP (based on indication) [thats not really a proper answer is it?]

Question 10

Onset, Duration

Answer 10

Onset - 1-3 mins
Peak - Unknown
Duration - 30 mins

Question 11

Special Considerations

Answer 11

• Do NOT shake container prior to administration
• Nitro comes in forms other than spray &/or tablet, none of which are approved for EMR use. If your PT has a NTG patch applied or is prescribed NTG tablets, it does NOT change Nitro protocol
• If pain is completely relieved for more than 5 mins, you may initiate chest pain protocol again if pain returns; this is considered a new episode