NITROGLYCERIN (NITROSTAT®)

CLASSES:

• Nitrate

• Antianginal

ACTIONS:

• Relaxes vascular smooth muscle leading to marked venodilation which decreases preload which in turn decreases intramyocardial wall tension, and mild to moderate arterial dilation which decreases afterload, which both lead to a decrease in myocardial oxygen demand

• Dilates large coronary arteries, antagonizes vasospasm, and increases coronary collateral blood flow to ischemic myocardium

• Reduces smooth muscle spasms of GI disorders

INDICATIONS:

• Angina Pectoris

• Acute hypertension

• AMI

• Acute Pulmonary Edema

CONTRAINDICATIONS:

• Allergy to nitrates

• Hypotension (Hawaii Standing orders have BP guidelines of >100 systolic before NTG should be administered ordered by the Medicom MD)

• Use of phosophodiesterase inhibitors for erectile dysfunction (Sildenafil, Vardenafil 24 hrs, Tadafil 72 hrs)

• RVI (Inferior MI with Hypotension)

STANDARD PREP: 400 mcg (0.4 mg ) spray, 0.4 mg SL tablets

DOSAGE/ROUTE:

• CP – 0.4 mg q 5min if BP>100 systolic

• PE – 0.4 mg q 5min if BP>100 systolic to total of 5x

• ACLS: Follow Algorithm

SIDE EFFECTS:

• Hypotension

• Dizziness

• Syncope

• Flushing

• Headache

• Reflex tachycardia

• Weakness

• Sting upon contact with mucous membrane

PRECAUTIONS:

• Monitor BP, and check if drug dissolved sublingually • Caution to expect headache, dizziness & flushing, a

  burning effect under tongue

• If possible, store in dark, cool, dry place. Environmental conditions may shorten stated expiration date

• When using spray, coach pt to open mouth wide and lift tongue

• Sit pt. up if BP permits it as you administer NTG. Supine position increases preload and offsets benefits

• Nitrate-induced hypotension responds well to supine position then fluid infusion prn since therapeutic effects are more a function of intravascular volume status than dose

• Vardenafil, Sildenafil, Tadalafil- produces hypotension