Nitrovasodilators

Question 1

List the most frequent uses of sodium nitroprusside.

Answer 1

Hypertensive emergencies, acute cardiac disorders, and
controlled hypotension to decrease surgical blood loss.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 198.

Question 2

What is the advantage of using nitroprusside for the

rapid control of blood pressure?

Answer 2

It has a rapid onset and a short duration of action.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 198.

Question 3

How does nitroprusside affect arterioles, veins, and

cardiac filling pressures?

Answer 3

Nitroprusside causes dilation in both veins and arteries. The
result is a reduction of both preload and afterload which causes
a reduction of cardiac filling pressures.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: .

Question 4

How does nitroprusside affect systemic vascular

resistance (SVR)?

Answer 4

It causes a significant decrease in SVR
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 747.

Question 5

What are the pulmonary effects of nitroprusside?

Answer 5

There is dilation of the pulmonary vasculature and a reduction
of pulmonary vascular resistance (PVR). Nitroprusside causes
direct inhibition of hypoxic pulmonary vasoconstriction.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 747.

Question 6

Can nitroprusside produce coronary steal?

Answer 6

Yes. Nitroprusside can cause blood to be shunted away from
areas of myocardial ischemia.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 747.

Question 7

List perioperative uses of IV nitroglycerin.

Answer 7

Nitroglyercerin can be used perioperatively in the treatment of
CHF, myocardial ischemia, systemic and pulmonary
hypertension, acute volume overload, coronary artery spasm,
and controlled hypotension. During cardiac surgery, IV
nitroglycerin is used to aid in transfusion of blood and infusion
of oxygenator reservoir volume.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 751.

Question 8

How does nitroglycerin affect the coronary arteries?

Answer 8

It is a direct dilator of the coronary arteries. Because of this
property, nitroglycerin is extremely useful in the treatment of
angina due to coronary vasospasm.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 750.

Question 9

Does nitroglycerin inhibit hypoxic pulmonary

vasoconstriction?

Answer 9

Yes, but to a lesser degree than sodium nitroprusside.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 749.

Question 10

List 3 common adverse effects of nitroglycerin.

Answer 10

Headache, hypotension, flushing
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 751.

Question 11

By what routes may nitroglycerin be administered

clinically?

Answer 11

IV, transdermal, oral, and sublingual.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 750-
751.

Question 12

Can patients develop a tolerance to nitroglycerin?

Answer 12

Yes, however this mechanism is not fully understood.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 751.

Question 13

Can nitroglycerin be used in the treatment of narcotic

induced biliary spasm?

Answer 13

Yes. Nitroglycerin causes relaxation of biliary tract smooth
muscle.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 199.

Question 14

Why is a nitroprusside infusion bottle covered in a

protective wrap?

Answer 14

Nitroprusside decomposes when exposed to light.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 198.

Question 15

What are the hemodynamic effects of nitroglycerin?

Answer 15

Nitroglycerin produces venodilation and an increase in venous
capacitance. The result is a reduction in preload. There are
decreases in left ventricular end-diastolic volume, pulmonary
vascular resistance, pulmonary artery pressure, and right
ventricular end-diastolic pressure. Myocardial wall tension is
decreased which results ultimately in a reduction in myocardial
oxygen requirements.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 749.