Gtn

Front 1

GTN preparation

Back 1

Metered dose bottle, delivers 0.4mg dose

Front 2

GTN indications

Back 2

Myocardial ischemia, cardiogenic pulmonary oedema

Front 3

GTN contraindications

Back 3

Hypersensitivity to GTN, systolic BP less than 100mmhg, HR less than 40bpm/ greater than 150bpm, erectile dysfunction/ pulmonary hypertension medication in last 24hrs

Front 4

GTN precautions

Back 4

Small/frail/unstable, inferior stemi, poor perfusion, dysthymia present, erectile dysfunction medication in last 24hrs, known aortic stenosis

Front 5

GTN administration

Back 5

Sub-linguial spray, can spray onto tongue if needed

Front 6

GTN dose

Back 6

0.4mg-0.8mg SL, repeat every 2-5 mins

Front 7

GTN onset

Back 7

1-2 mins

Front 8

GTN mechanism of action

Back 8

Vasodilator - dilated veins and arteries, primarily acts on veins. Helps form nitric oxide which is a Vasodilator. Causes venous dilation, which causes peripheral blood pooling, reducing venous preload and return. This reduces ventricular refilling and cardiac output, which reduces myocardial work/ oxygen demand.

Dilates arteries, reducing peripheral resistance and afterload. Reduces the force the left ventricle must overcome to eject blood into the systemic circulation, reducing myocardial oxygen demand. Dilates the coronary artery slightly, increasing the supply of blood to the myocardium.

Front 9

GTN duration

Back 9

10-30 mins, though may be prolonged several hours in some patients

Front 10

GTN adverse effects

Back 10

Hypotension, flushing, headache, tachycardia, light-headedness

Front 11

GTN interactions

Back 11

Effects increased in patients taking beta-blockers/ hypotensive drugs. Erectile dysfunction medication can prolong hypotension.

Front 12

GTN pharmacokinetics

Back 12

Rapidly absorbed in the mucosa (initially bypasses liver) and reaches vascular system. Metabolized in liver, some metabolites have vasodilatory effects. Metabolites excreted in urine.