Nitroglycerine (Nitrostat)

Question 1

Class (2)

Answer 1

• Nitrate

- Antianginal

Question 2

Actions (3)

Answer 2

• Relaxes vascular smooth muscle leading to marked venodilation which decreases preload which in turn decreases intramyocardial wall tension, and mild to moderate arterial dilation which decreases afterload which both lead to a decrease in myocardial O2 demand
• Dilates large coronary arteries, antagonizes vasospasm, and increases coronary collateral blood flow to ischemic myocardium
• Reduces smooth muscle spasms of GI disorders

Question 3

Indications (4)

Answer 3

• Angina pectoris
• AMI
• Acute HTN
• Acute pulmonary edema

Question 4

Dose/Route

Answer 4

• See HI S.O.

- ACLS: follow algorithm

Question 5

Contraindications (2)

Answer 5

• Allergy to nitrates
• Hypotension (HI S.O. have BP guidelines >100 systolic before NTG should be administered unless ordered by the Medicom MD)

Question 6

Side Effects (7)

Answer 6

• HA, dizziness, flushing, syncope
• Hypotension, reflex tachycardia
• Sting upon contact with mucous membrane

Question 7

Precautions

Answer 7

• Monitor BP, and check if drug dissolved sublingually
• Caution to expect HA, dizziness & flushing, a burning effect under tongue
• If possible, store in dark, cool, dry place
• Environmental conditions may shorten stated expiration date
• When using spray, coach pt to open mouth wide and lift tongue
• Sit pt up if BP permits it as you administer NTG–supine position increases preload and afterload
• Nitrate-induced hypotension responds well to supine position then fluid infusion prn since therapeutic effects are more a function of intravascular volume status than dose