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Nitroglycerin, a nitrate, causes smooth muscle relaxation. This produces systemic venous pooling of blood through the action of vasodilation. This, in effect, decreases venous blood flow return to the heart and reduces preload as well as venous afterload. This should be watched closely as to not cause detrimental hypotension. Nitroglycerin is indicated to relieve chest discomfort suspected to be the result of an acute myocardial infarction, otherwise known in short as an AMI. It can also be effective in relieving cardiogenic pulmonary edema related to left side heart failure. Now there are multiple situations where the use of nitro may not be indicated or may even be contraindicated and actually harmful to the outcome of the patient. For instance, if the patient is suffering from a low systolic blood pressure of less than 90 mmHg. Or maybe they have right-sided ventricular infarction going on. Or maybe they’re using tadalafil, sometimes better known as Cialis or Adcirca, within the past 48 hours. Maybe they have severe bradycardia of less than 50 beats per minute or a tachycardia greater than 100 beats per minute in the absence of heart failure. Different from tadalafil but in the same class of complication with nitro, when the patient may be taking a phosphodiesterase type 5. That’s a class of medication that is included in sildenafil within the past 24 hours and nitro could cause severe hypotensive side effects if they’re using that medication and take nitro. Now it’s important to gather a thorough medication list from the patient or from a reliable family member or caregiver so as to avoid serious contraindications by mixing these medications. Nitro should be administered sublingually in the dose of 0.4 mg, which is usually 1 tablet. Now this can be repeated in 5-minute intervals to a maximum of three tablets. Nitro can also be administered via a sublingual spray, which is given with 1 spray equivalent to 0.4 mg in metered doses. This too can be repeated in 5-minute intervals to a maximum of three sprays. Nitro can be administered IV and may increase to 10 mcg per min every 3 to 5 minutes until you reach your desired effect. Now it’s going to be important to monitor serial blood pressure and treat hypotension accordingly.
In this lesson, we'll go over the medication nitroglycerin and all of its effects, including its mechanism of action, indications, precautions, contraindications, and adult dosages.
Nitroglycerin, a nitrate, causes smooth muscle relaxation. This produces systemic venous pooling of blood through the action of vasodilation. This, in effect, decreases venous blood flow return to the heart and reduces preload as well as venous afterload.
Pro Tip #1: The administration of nitroglycerin should be watched closely so as to not cause detrimental hypotension. Always monitor serial blood pressure and treat hypotension accordingly.
Nitroglycerin is clinically indicated to treat the following conditions:
There are multiple situations where the use of nitro may not be indicated, or may even be contraindicated and actually harmful to the outcome of the patient. Do not administer nitroglycerin if any of the following are present:
Pro Tip #2: Because of these severe drug interactions, it is vitally important to gather a thorough medication list from the patient, or from a reliable family member or caregiver, before administering nitroglycerin.
When administering nitroglycerin to adult patients, look to the following protocol based on the route of administration: