nitroglycerin (Nitrostat®)
Vasodilator
It was originally believe that nitrates and nitrites dilated coronary blood vessels, thereby increasing blood flow to the heart. It is now believed that atherosclerosis limits coronary dilation and that the benefits of nitrates and nitrites are due to dilation of arterioles and veins in the periphery. The resultant reduction in preload, and to a lesser extent in afterload, decreases the workload of the heart and lowers myocardial oxygen demand. Nitroglycerin is very lipid soluble and is thought to enter the body from the GI tract through the lymphatics, rather than the portal blood.
1-3 minutes
20-30 minutes
Ischemic chest pain
Hypertension
CHF
Hypersensitivity
Use of Viagra® within past 24 hours.
Hypotension
Use of
Head injury
Cerebral hemorrhage
Transient headache
Postural syncope
Reflex tachycardia
Hypotension
Nausea and vomiting
Diaphoresis
Other vasodilators may have additive hypotensive effects.
Tablets: 0.15 (1/400 gr), 0.3 mg (1/200 gr), 0.4 mg (1/150 gr), 0.6 (1/100 gr)
Spray: 0.4 mg per spray
IV Infusion: begin at 5 mcg/min, increasing at 10 mcg/min increments until desired response achieved (complete pain relief/desired BP)
Tablet: 0.3 - 0.4 mg SL, repeat in 5 minutes, titrated to pain relief.
Infusion: 10-20 mcg/min; increase by 5-10 mcg/min every 5-10 minutes until desired effect
Not recommended.
Pregnancy Safety: Category C
Increased susceptibility to hypotension in the elderly
Nitroglycerin decomposes when exposed to light or heat
Must be kept in airtight containers
Active ingredient of nitroglycerin will "sting" when administered SL
Administer IV nitroglycerin by infusion pump to ensure precise flow rate.