Glyceryl Trinitrate D013 (210920)

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GTN Presentation

Back 1

0.3mg tablet

0.6mg tablet

Transdermal GTN patch (0.4mg/hr)

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GTN Pharmacology

Back 2

Principally: a vascular smooth muscle relaant

Actions:
1. Venous dilation promotes venous pooling and
reduces venous return to the heart
(reduces preload)
2. Arterial dilation reduces systemic vascular
resistance and arterial pressure
(reduces afterload)

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GTN Actions

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Actions:1. Venous dilation promotes venous pooling and reduces venous return to the heart (reduces preload)

2. Arterial dilation reduces systemic vascular resistance and arterial pressure (reduces afterload)

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GTN Effects

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1. Reduced myocardial oxygen demand

2. Reduced systolic, diastolic and mean arterial pressure, whilst usually maintaining coronary perfusion pressure

3. Mild collateral coronary arterial dilation may improve blood supply to ischaemic areas of myocardium

4. Mild tachycardia secondary to slight fall in blood pressure

5. Preturm labour : uterine quiescence in pregnancy

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GTN Metabolism

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By the liver

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GTN Primary Emergency Indicatons

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1. Chest pain associated with acute coronary syndrome

2. Acute left ventricular failure

3. Hypertension associated with acute coronary syndrome
4. Autonomic dysreflexia
5. Preterm labour (consult)

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GTN Contraindications

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1. Known hypersensitivity
2. Systolic blood presure <110 tablet
3. Systolic blood pressure <90 patch
4. Sildenafil Citrate "Viagra or Vardenafil "Levitra" administration in the prevous 24hr or Tadalafil "Cialis" administration in the prevous 4 days

(PEA5 Inhibitors)
5. Heart rate > 150
6. Bradycardia HR <50

(excl autonomic dysreflexia)
7. Ventricular tachycardia
8. Inferior STEMI with systolic BP <160
9. Right ventricular infarct

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GTN Precautions

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1. No previous administration

2. Elderly patients

3. Recent acute myocardial infarction

4. Concurrent use with other Tocolytics

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GTN Route of Administration

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Buccal

Sublingual

Transdermal

Infusion (interhospital transfer only)

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GTN Side Effects

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1. Tachycardia

2. Hypotension

3. Headache

4. Skin flushing (uncommon)

5. Bradycardia (occasionally)

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GTN Special Notes - storage

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1. Storage: GTN is susceptible to heat and moisture.
Make sure that tablets are stored in their original
light resistant, tightly sealed bottles, the foil pack
of the patches should be intact.

2. Do not administer patients own medication,

as its storage may not have been in optimal conditions or may be

expired.

3. Patches should be discarded prior to use-by date.

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GTN Special Notes - Interhospital Transfer (IHT)

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GTN by intravenous infusion may be required for an IHT as per the treating doctor's orders.

Dosage:- The IV dose is to be prescribed and signed by the referring hospital medical officer.-

Usually in the range of 5 mcg/min to 200 mcg/min and increased 3-5 mcg/min.

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GTN Special Notes - interactions

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1. Both men and women can be prescribed PDE5 inhibitors. All patients should be asked if / when they last had the medication to determineGTN is C/I.4.

2. Tadalafil (Cialis) may also be prescribed to men for treatment of benign prostatic hypertrophy. New indication for this medication.

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GTN -Times Buccal and transdermal

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Buccal Effects:
Onset: 30 sec - 2 min
Peak: 5-10 mins
Duration: 15-30 mins

Transdermal Effect:
Onset: up to 30 min
Peak: 2 hrs

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GTN -Times IV admin

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Intravenous Effects:

Onset: 30 sec - 1min

Peak: 3-5 mins

Duration: 15-30 mins