NITROGLYCERIN

Class

Vasodilator

Pharmacology and Actions

1. Cardiovascular effects include:
   1. Reduced venous tone, causes blood pooling in peripheral veins, decreasing venous return to the heart.
   2. Decreased peripheral resistance
   3. Dilatation of coronary arteries (if not already at maximum) and relief of coronary artery spasm.
2. Generalized smooth muscle relaxation

Indications

1. Angina
2. Chest, arm, or neck pain caused by coronary ischemia
3. Patients with 12-lead evidence of acute MI, with / without chest pain
4. Cardiogenic pulmonary edema: to increase venous pooling, lowering cardiac preload and afterload.

Contraindications

1. Children younger than 12 years of age.
2. Patients currently using Viagra or similar drugs (male or female).

Precautions

1. Generalized vasodilitation may cause profound hypotension and reflex tachycardia.
2. Use with extreme caution in hypotensive patients.
3. Use with caution in patients with EKG evidence of a right ventricular infarct.

Administration

1. Oral: 0.4 mg tablet / spray sublingually, may repeat every 3-5 minutes as needed for effect.

Side Effects and Special Notes

1. Common side effects include throbbing headache, flushing, dizziness, and burning under the tongue (if given orally), these side effects may be used to check potency.
2. Less common:  orthostatic hypotension, sometimes marked.
3. NOTE:  Therapeutic effect is enhanced, but adverse effects are increased when patient is upright.
4. Because nitroglycerin causes generalized smooth muscle relaxation, it may be effective in relieving chest pain caused by esophageal spasm.
5. May be effective even in patients using paste, discs, or oral long-acting nitrate preparation.
6. Patients taking Viagra or similar drugs should not be given nitroglycerin.