DTP Glyceryl Trinitrate

Question 1

Drug class of GTN

Answer 1

Vasodilator

Question 2

Pharmacology of GTN

Answer 2

Pools venous blood in the peripheral veins.
Increases venous capacity decreasing preload.
Reduce ventricular filling pressures.
Decreasing arterial blood pressure.
Vasodilates coronary arteries that are in spasm.
May assist the redistribution of blood flow through collateral channels of the heart.

Question 3

Metabolism of GTN

Answer 3

Readily absorbed and metabolised by the liver

Question 4

Indications for GTN

Answer 4

1. Suspected ACS
2. cardiogenic APO
3. Autonomic dysreflexia with a systolic >= 160 mmHg
4. Irrukandji syndrome with a systolic >= 160 mmHg

Question 5

Contraindications for GTN

Answer 5

1. KSAR
2. Head trauma
3. Acute CVA
4. Heart rate < 50 or >150 bpm
5. Bp < 100 mmHg
6. Erectile dysfunction medications in last 24 hrs

Question 6

Precautions of GTN

Answer 6

1. Cerebral vascular disease
2. Intoxicated pts
3. Risk of hypotension / syncope
4. Suspected inferior AMI
5. Erectile dysfunction medications in last 4 days
6. Pt w/normal or low left ventricular filling pressures may be hypersensitive to GTN.

Question 7

Side effects of GTN

Answer 7

1. Dizziness
2. Vascular headache
3. Syncope
4. Hypotension
5. Reflex tachycardia

Question 8

Presentation of GTN

Answer 8

Sublingual spray 400 mcg

Ampoules 50 mg in 10 mls*

Question 9

Onset of GTN

Answer 9

< 2 mins

Question 9

Duration of GTN

Answer 9

20-30 mins

Question 10

Half-life of GTN

Answer 10

5 mins

Question 12

Special notes for GTN

Answer 12

1. GTN first for ACS
2. GTN first for autonomic dysreflexia
   morphine should be considered as Mx

Question 13

When should IV GTN be considered?

Answer 13

All pts unresponsive to sublingual GTN, narcotics and betablockers.