Nitroglycerine (Nitrostat)

Question 1

Classes

Answer 1

Nitrate

Antianginal

Question 2

Actions

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 oxygen demand.
Dilates large coronary arteries, antagonizes vasospasm, and increases coronary collateral blood flow to the ischemic myocardium.
Reduces smooth muscle spasms of GI disorders

Question 3

Indications

Answer 3

Angina pectoris
AMI
Acute hypertension
Acute Pulmonary Edema

Question 4

Dosage

Answer 4

0.4 mg (1/150) grain spray sub-lingual.

Question 5

Contraindications

Answer 5

Allergy to nitrates
Hypotension (Hawaii standing orders have BP guidelines of > 100 systolic before NTG should be administered unless ordered by the medicom MD)

Question 6

Side Effects

Answer 6

Headache
Hypotension, reflex tachycardia
Sting upon contact with mucus membrane

Question 7

Precautions

Answer 7

Caution to expect headache, dizziness and flushing, a burning effect under tongue
If possible, store in a dark, cool, and dry place
Environmental conditions may shorten stated expiration date
When using spray, coach patient to open mouth wide and lift tongue
Sit patient up if BP permits it as you administer NTG. Supine position increases preload and offsets benefits
Nitrate-induced hypotension responds well to supine position then fluid infusion prone since therapeutic effects are more a function of intravascular volume status than dose.