Nitroglycerin (Nitrostat®)

Question 1

Nitro Drug Classification

Answer 1

Vasodilator / Nitrate

Question 2

Nitro Mechanism

Answer 2

Nitroglycerin is a pro-drug which must be de-nitrated to form the active metabolite nitric oxide (NO). Then, NO activates the conversion of GTP to cGMP + 2Pi in vascular smoother muscle cells (VSMC). cGMP activates a cascade of reactions that cause a reduction in intracellular Ca2+, VSMC relaxation (in arterioles) and decreased cardiac preload and afterload.

Question 3

Nitro Onset of Action

Answer 3

1 - 2 minutes IV, 1 -3 minutes SL, 30 minutes topical

Question 4

Nitro Peak Effects

Answer 4

5 - 10 minutes SL, varies topical

Question 5

Nitro Duration of Effect

Answer 5

20 - 30 minutes SL, 3 - 6 hours topical

Question 6

Nitro Half-Life

Answer 6

1 - 4 minutes

Question 7

Nitro Indications / Field Use

Answer 7

Chest pain associated with angina or MI, acute pulmonary edema / CHF

Question 8

Nitro Contraindications

Answer 8

Shock, hypotension, increased ICP, Children under 12, ED drugs within 48 hours

Question 9

Nitro Side Effects / Adverse Reactions

Answer 9

Headache, dizziness, weakness, tachycardia, hypotension, rash, dry mouth, N+V

Question 10

Nitro Dosing Spray/Tablet (ADULT)

Answer 10

0.4 mg SL q 3-5 minutes until effect achieved or BP drops (max 3 x 25 minutes)

Question 11

Nitro Dosing Paste (ADULT)

Answer 11

0.5 - 1 inch topical

Question 12

Nitro Precautions

Answer 12

Expect headache from cerebral vasodilation, routine use may cause tolerance, 12-lead ECG prior to administration - use extreme caution if R-side MI

Question 13

Nitro Drug-Drug interactions

Answer 13

Orthostatic hypotension with β-blockers, severe hypotension with alcohol.