nitroglycerin (Nitrostat, NitroQuick, NitroBid, Tridil)

Question 1

nitroglycerin (Nitrostat, NitroQuick, NitroBid, Tridil)
Pharmacology and actions

Answer 1

Reduces peripheral vascular resistance, preload, afterload, cardiac workload
and myocardial oxygen demand. Smooth muscle relaxant which acts on smooth muscle of uterus,
intestine, bronchial tree and blood vessels. Dilates peripheral arterioles and veins.

Question 1

nitroglycerin (Nitrostat, NitroQuick, NitroBid, Tridil)
Class

Answer 1

Vasodilator, nitrate, antianginal

Question 2

nitroglycerin (Nitrostat, NitroQuick, NitroBid, Tridil)
Onset, Duration, Peak effect

Answer 2

Onset: 1-3 minutes Duration: 20-30 minutes SL. 1-10 minutes after discontinuation of IV infusion. Peak
Effect: 5-10 minutes

Question 3

nitroglycerin (Nitrostat, NitroQuick, NitroBid, Tridil)
indications and contraindications

Answer 3

Indications
● Ischemic chest pain
● Acute and symptomatic hypertension
● Heart failure
● Pulmonary edema
IV. Contraindications
● Hypotension (SBP <90 OR at least 30mmHg below baseline)
● Hypovolemia
● Intracranial bleeding
● Head injury
● Cardiac tamponade
● Severe brady/tachycardia
● Right ventricular infarct
● Sildenafil (Vaigra) or vardenafil (Levitra) within 24 hours
● Tadalafil (Cialis) within 48 hours
● Hepatic disease (relative)
● Anemia (relative)
● Diabetes (relative)
● Breastfeeding mothers and pregnancy (relative)

Question 4

nitroglycerin (Nitrostat, NitroQuick, NitroBid, Tridil)
Adverse reactions and side effects

Answer 4

Cardiovascular: Reflex tachycardia, syncope, hypotension
Neurological: Headache, dizziness, weakness, muscle twitching
Other: Diaphoresis, dry mouth

Question 5

nitroglycerin (Nitrostat, NitroQuick, NitroBid, Tridil)
Dosage

Answer 5

Adult
Ischemic chest pain, hypertension: Sublingual: 0.3-0.4mg tablet every 3-5 minute to a maximum
of 3 doses. Spray: 1-2 sprays every 3-5 minutes to a maximum of 3 doses. IV: 12.5-25mcg bolus
(if no SL/spray given), then begin 10mcg/min infusion. Increase by 10mcg/min every 3-5 minutes
until desired effect. Maximum dose: 200mcg/min. Paste: Squeeze out the dose onto a supplied
paper dose-measuring applicator that comes with the medication. Place the paper applicator with
ointment side down onto a dry, hairless area of skin (preferred on the chest). Do not rub ointment
into skin.
Mild CHF/pulmonary edema: 0.4mg SL. Repeat q 5 minutes.
Severe CHF/pulmonary edema: SBP 100-150: 0.4mg SL. SBP 150-200: 0.8mg SL.
SBP >200: 1.2mg SL. Repeat doses every 5 minutes based on repeat SBP.

Question 6

nitroglycerin (Nitrostat, NitroQuick, NitroBid, Tridil)
Special considerations

Answer 6

● Hypotension is more common in older patients.
● IV NTG must be administered with an infusion pump direct from the bottle.
● If a 12-lead EKG shows an inferior wall infarct, rule out RV infarction with a right-sided
12-lead before administering NTG

Question 7

nitroglycerin (Nitrostat, NitroQuick, NitroBid, Tridil)
Drug interactions

Answer 7

● Incompatible with other drugs given IV
● Increased hypotensive effect with alcohol and phenothiazines