Nitroglycerine (Nitrostat)

Question 1

NTG Classification

Answer 1

Vasodilator/Nitrate

Question 2

NTG Mechanism

Answer 2

NTG is a prodrug which must be denitrated to form the active metabolite Nitric Oxide (NO). Then NO activates the conversion of cGTP->cGMP + 2Pi in VSMC. cGMP activates a cascade of reactions that cause a decrease in intracellular Ca2+, VSMC relaxation (in arterioles), and decreased cardiac preload and afterload

Question 3

NTG Pharmacokinetics

Answer 3

Onset: 1-2m IV, 1-3m SL, 30m topical
Peak Effects: 5-10m SL, varies topical
Duration: 20-30m SL, 3-6h topical
Half Life: 1-4m

Question 4

NTG Indications

Answer 4

• CP associated with angina or MI

- Acute pulmonary edema/CHF

Question 5

NTG Contraindications

Answer 5

• Hypotension/Shock
• Increased ICP
• ED drug use w/in 48hrs
• Children <12y/o

Question 6

NTG Side Effects/Adverse Reactions

Answer 6

HA, dizziness, weakness, tachycardia, hypotension, rash, dry mouth, N/V

Question 7

NTG Dose

Answer 7

Adult:
Tablet/Spray: 0.4mg SL q3-5m until effect acheived or BP drops (max 3 in 25 min)
Paste: 0.5-1 inch topically

Pedi:
Not for pediatrics

Question 8

NTG Precautions

Answer 8

• Expect HA from cerebral vasodilation
• Routine use may cause tolerance
• 12-lead EKG prior to administration extreme caution if rightsided MI

Question 9

NTG Drug Interactions

Answer 9

Orthostatic hypotension with Beta blockers, severe hypotension with EtOH