Nitroglycerin*

• Nitroglycerin

• Nitro-Dur

Classification:

• Anti-angina, vascular smooth muscle relaxer, vasodilator

Mechanism of Action:

• Relaxes vascular smooth muscle, there by dilating the veins and arterioles (at higher doses), causing blood pooling, which reduces the preload thus decreasing workload of the heart muscle
• Reduces left ventricular systolic wall tension, which decreases afterload
  

Indications:

• Possible ischemia due to ACS:
  • Unstable angina
  • AMI
• Pulmonary edema/CHF

Contraindications:

• Hypotension (< 90 mmHg)
• Severe bradycardia/tachycardia (< 50 or > 150 bpm)
• Increase ICP or intracranial hemorrhage
• Patients taking erectile dysfunction medications
  • Viagra within 24 hours
  • Cialis, Levitin, Staxyn within 36 hours

Precautions:

• Administration to Right Ventricular Infarction patients, due to preload dependency, can result in hypotension

Adverse Effects:

• Headaches
• Hypotension
• Bradycardia
• Postural syncope
• Weakness
• Dizziness
• Nausea/vomiting
• Reflex tachycardia

Dose:

• 0.4 mg SL q 3 - 5 min (PCP dosage)
• Infusion 5.0 mcg/min titrate to effect increasing 5.0 – 10.0 mcg/min q 5-10 min

• SL, IV

• Nitroglycerin is not contraindicated for all inferior STEMIs, only inferior STEMIs with right ventricular involvement. Anytime ST elevation is noted in any one of the inferior leads (II, III or aVF), the V4 electrode should be moved to the 5th intercostal space on the patients’ right side to become V4R. After acquiring a modified 12 lead, if 1mm or more of ST elevation is noted in V4R nitroglycerin should not be administered.
• It is important to check a blood pressure before and after nitroglycerin administration.
• Hypotension may be more pronounced in a patient who has not previously taken nitroglycerin.
• Pregnancy category C [if the patient will benefit from a Category C drug, it is generally used]

• Compendium of Pharmaceuticals and Specialties (CPS)
• Pharmacology for the Prehospital Provider 2nd Edition