MED-Nitroglycerin

Nitrate

• Rapid vascular smooth muscle relaxant resulting in increased coronary blood flow and improved perfusion of myocardium
• Results in decreased venous return to the heart, alleviation of CP, and decreased preload and afterload of left ventricle

• CP associated with angina pectoris or AMI
• Acute pulmonary edema
• CHF

• Hypersensitivity
• Head trauma
• Patients in shock (systolic < 90mmHg)
• Patients with increased ICP

• Protect from light and air
• Monitor vitals closely for orthostatic hypotension
• Posphodiesterase-type 5 (PDE-5) inhibitors:
• Viagra: use within past 24 hours
• Cialis: use within past 48 hours
• Levitra: use within past 48 hours

• Hypotension
• Palpitations
• Tachycardia
• Syncope
• Dry mouth
• N/V
• Headache
• Dizziness
• Skin rash

May cause hypotension when used in conjunction with alcohol and antihypertensives (beta-blockers)

• 0.4 mg SL (or 1/150 gr) tablet or spray q 5 mins with BP >100 systolic
• 1-2 inches of paste

• Infusion:
• 10 mcg/min IV infusion pump increasing 5-10 mcg/min q 5 mins to relieve CP or pulmonary edema
• (if systolic BP >100 mmHg)

• Onset = 1-3 mins SL, 30 mins TD
• Half-life = 1-4 mins

• Recommend two IVs or twin-cath in place to administer infusion.
• Do not shake aerosol spray as it may effect metered dose.