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12 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What are the best-known trade names for nitroglycerin?
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Nitrostat, Nitro-Bid, Tridil
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Other trade names include Nitrospan, Nitrol, Trinipatch, Nitro-Dur, Natispray and NitroMist.
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What is the functional class of nitroglycerin?
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Nitrate
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Other nitrates include isosorbide mononitrate (Imdur), isosorbide dinitrate (Isordil) and pentaerythritol tetranitrate (Lentonitrat).
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What is the mechanism of action of nitroglycerin?
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Rapid vascular smooth muscle relaxant that increases coronary blood flow and improves perfusion of the ischemic myocardium. This results in decreased venous return to the heart, alleviation of chest pain, and a decrease in preload and afterload in the left ventricle.
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The effects of NTG (and other nitrovasodilators) is achieved by denitration to produce nitric oxide (NO) which is a potent vasodilator.
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What are the listed indications for nitroglycerin?
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- Chest pain associated with angina pectoris or AMI
- Acute pulmonary edema - Congestive heart failure |
NTG is also used to treat hypertension, coronary artery spasms due to cocaine and topically for anal fissures.
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What are the listed contraindications for nitroglycerin?
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- Hypersensitivity
- Head trauma - Patients in shock (systolic BP < 90 mmHg) - Patients with increased ICP (head trauma) |
Some sources also list anemia.
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What are the listed precautions for nitroglycerin?
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- Protect from light and air.
- Monitor vitals closely as it may cause orthostatic hypotension - Phosphodiesterase-type 5 (PDE-5) inhibitors: -- Viagra (sildenafil) use within the past 24 hours -- Cialis (tadalafil) use within the past 48 hours -- Levitra (vardenafil) use within the past 48 hours |
There is no evidence that defibrillation across a transdermal NTG patch can cause explosion or fire.
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What are the listed side effects for nitroglycerin?
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- Hypotension
- Palpitations - Tachycardia - Syncope - Dry mouth - N/V - Headache - Dizziness - Skin rash |
Prolonged, repeated use of NTG can lead to tolerance. The severe headaches associated with NTG may necessitate analgesia in some patients and are a significant cause of lack of compliance.
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What are the listed interactions for nitroglycerin?
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May cause hypotension when used in conjunction with alcohol and antihypertensives (beta-blockers)
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Orthostatic hypotension has been reported when calcium channel blockers and nitrates were used concomitantly.
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What is the dosage and route of nitroglycerin?
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- 0.4mg SL (or 1/150gr) tablet or spray q 5 minutes prn with BP>100mmHg.
- 1-2 inches of TD paste Infusion: 10mcg/min via IV infusion pump increasing by 5-10 mcg/minute q 5 minutes to relieve CP or pulmonary edema (if systolic BP>100mmHg) |
NH protocols require an IV be established before SL NTG can be administered (with the exception of assisting a pt with their own medication).
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What are the pharmacokinetics of nitroglycerin?
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Onset: 1-3 minutes SL, 30 minutes TD
Half-Life: 1-4 minutes |
Effect reaches a maximum 5 minutes after SL administration and persists for at least 25 minutes.
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What should be performed before a nitroglycerin infusion is started?
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Recommend two IVs or a TwinCath in place to administer infusion.
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This is a requirement in NH protocols, as is the use of an infusion pump.
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How should nitroglycerin spray be handled?
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Do not shake aerosol spray as it may affect metered dose.
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However, medicinal NTG is not explosive...
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