nitroglycerin

Question 1

Classification

NTG

Answer 1

• Antianginal

Nitrate

Question 2

INDICATIONs

NTG

Answer 2

[EMR]
relief of CP suggestive of ACS

[ACP]
decrease preload in Acute Cardiopulmonary Edema

Question 3

CONTRAINDICATIONs

NTG

Answer 3

*SBP < 110mmHg*
*HR < 50 > 150*

• HYPERSENSITIVITY - other nitrates
• Viagra or Levitra use - past 24 hrs
• Cialis use - past 48 hours
• hypotension // uncorrected hypovolemia
• severe anaemia
• constrictive pericarditis
• pericardial tamponade
• hx R-sided MI // 12 lead ECG

relative contra indication - open // closed angled glaucoma

Question 4

Dosage - Adult

NTG

Answer 4

[EMR] - cliniCALL REQUIRED if no rx
0.4mg spray SL - repeat q 3-5mins
- verify - BP ≥110 systolic + HR > 50 / < 150bpm

Question 5

Pharmacodynamics

NTG

Answer 5

• Relaxes vascular smooth muscle - predominantly a venodilator; also produces coronary and systemic arterial vasodilation to a lesser extent
• Decreases preload, decreases MVO2 (myocardial oxygen consumption)

Question 6

Pharmacodynamic (c-GMP)

NTG

Answer 6

• NTG releases nitric oxide in vascular endothelial cells. Nitric oxide is a gas, which when released in the vascular smooth muscle, results in the formation ofcyclice guanosine monophosphate (Cyclic GMP)
  c-GMP relaxes vascular smooth muscle by inactivating myosin light-chain kinase or by stimulating dephosphorelation of myosin phosphate

Question 7

Pharmacokinetics

NTG

Answer 7

-SL
 onset - 30s-2mins
 peak - 5-10mins
 half-life - 1-4mins
 duration - 15-30mins

Question 8

ADVERSE EFFECTs

NTG

Answer 8

• Hypotension
• Nausea
• Headache

Question 9

Warning // Precautions

NTG

Answer 9

@RISK pts w/
- hx hepatic or renal insufficiency
- rx anti-hypertensives
- clinically significant aortic stenosis
- documented inferior ischemia w/ 12-lead ECG

Question 10

DRUG INTERACTIONs

NTG

Answer 10

• ETOH may have additive vasodilatory effects that may lead to hypotension
• may act synergestically w/ anti-hypertensives

Question 11

Special Notes

NTG

Answer 11

• For infusion: Nitro is generally mixed in a glass bottle. IV bags are made of polyvinylchloride (PVC) which absorbs the drug and decreases the concentration
• In hospital, cardiac ischemic chest pain that does not respond to NTG SL and morphine IV is treated with a NTG infusion (typical mix: 50 mg in 250 cc - started at 10-20 µg/min and titrated in 10 µg/min increments to relieve pain)