Nitroglycerin Spray Flashcards
Drug classification
Vasodilator
Trade name
Nitrolingual
Actions (4)
- Dilates arterial and venous vessels resulting in Venous pooling
- Reduces preload and afterload resulting in decreased myocardial workload and reduced oxygen demand
- Dilates coronary vessels resulting in increased perfusion of the myocardium
- Relieves coronary vasospasm
Indications (2)
- Chest pain of suspected myocardial origin – myocardial ischemia
- Congestive heart failure/cardiogenic pulmonary edema
Contraindication (5)
- S/S of cerebral hemorrhage or increased ICP
- Poor systemic perfusion = systolic BP < 90 mmHg
- Severe bradycardia = < 50 bpm or tachycardia > 100 bpm
- Right ventricular MI
- Viagra (sildenafil citrate) or Levitra taken within the 24 hours or cialis (tadolafil) within 48 hours
Adverse effects - cardiovascular (6)
Hypotension* Bradycardia Rebound hypertension* Palpitations Reflex tachycardia* Postural syncope
Adverse effects - gastrointestinal (2)
Nausea/vomiting
Dry mouth
Adverse effects - neurological
Throbbing headache* Dizziness/faintness* Increased ICP Confusion Sublingual burning
Adverse effects - other
Flushed skin
Sublingual burning*
Administration - chest pain
1 spray (metered to 0.4 mg = 1/150th gain) SL or transmucosal
May repeat every 3-5 minutes x 2
Administration - CHF/Pulmonary Edema
- 4 mg SL or transmucosal (1 puff) if SBP is >_ 100
- 8 mg SL or transmucosal (2 puffs) if SBP >_ 150
- 2 mg SL or transmucosal (3 puffs) if SBP >_ 200
May repeat dose x 2
Pediatrics
Not recommended
Onset
1-3 minutes
Duration
30-60 minutes
Precaution
Monitor and record blood pressure before and within 5 min after administration of NTG
Do not administer if BP < 100 systolic
If so place patient in shock position
Rationale
Hypotension may result due to vasodilation or it may produce a synergistic hypotensive effect with alcohol, beta and calcium channel blockers, phenothiazine and non-nitrate vasodilators
If hypotension does not resolve, place patient in shock position and consider a fluid challenge if breath sounds are clear