NITROGLYCERIN (Nitrostat®)

Question 1

Generic/Trade Name

NITROGLYCERIN

Answer 1

Nitrostat®

Question 2

Generic/Trade Name

Nitrostat®

Answer 2

NITROGLYCERIN

Question 3

NITROGLYCERIN (Nitrostat®)

Drug Classification:

Answer 3

Vasodilator / Nitrate

Question 4

NITROGLYCERIN (Nitrostat®)

Mechanism of Action:

Answer 4

Nitroglycerin is a pro-drug which must be de-nitrated to form the active metabolite nitric oxide (NO). Then, NO activates the conversion of GTP⇒cGMP + 2Pi in vascular smooth muscle cells (VSMC). cGMP activates a cascade of reactions that cause a reduction in intracellular Ca2+, VSMC relaxation (in arterioles) and decreased cardiac preload and afterload.

Question 5

NITROGLYCERIN (Nitrostat®)

Pharmacokinetics

Answer 5

Onset of Action = 1-2 minutes IV, 1-3 minutes SL, 30 minutes topical

Peak Effects = 5-10 minutes SL, varies topical

Duration of Effect = 20-30 minutes SL, 3-6 hours topical

Half-Life = 1-4 minutes

Question 6

NITROGLYCERIN (Nitrostat®)

Indications/Field Use:

Answer 6

• Chest pain associated with angina or MI
• Acute pulmonary edema/CHF

Question 7

NITROGLYCERIN (Nitrostat®)

Contraindications:

Answer 7

• Shock, hypotension
• Increased ICP
• Children under 12
• ED drugs w/in 48 hours

Question 8

NITROGLYCERIN (Nitrostat®)

Side Effects/Adverse Reactions:

Answer 8

• HA,
• dizziness,
• weakness,
• tachycardia,
• hypotension,
• rash,
• dry mouth,
• N+V

Question 9

NITROGLYCERIN (Nitrostat®)

ADULT Dose:

Answer 9

• Spray (ADULT): 0.4mg SL q3-5min until effect achieved or BP drops (max 3x25min)
• Paste (ADULT): 0.5-1 inch Topical
• Tablet (ADULT): 0.4mg SL

Question 10

NITROGLYCERIN (Nitrostat®)

Precautions:

Answer 10

• Monitor vitals,
• expect HA from cerebral vasodilation,
• routine use may cause tolerance,
• 12-lead ECG prior to administration – use extreme caution if R-side MI

Question 11

NITROGLYCERIN (Nitrostat®)

Drug-Drug Interactions:

Answer 11

• Orthostatic hypotension with β-blockers,
• severe hypotension with alcohol