NITROGLYCERIN
From CRS EMS Guidelines
Class
Vasodilator
Pharmacology and Actions
- Cardiovascular effects include:
- Reduced venous tone, causes blood pooling in peripheral veins, decreasing venous return to the heart.
- Decreased peripheral resistance
- Dilatation of coronary arteries (if not already at maximum) and relief of coronary artery spasm.
- Generalized smooth muscle relaxation
Indications
- Angina
- Chest, arm, or neck pain caused by coronary ischemia
- Patients with 12-lead evidence of acute MI, with / without chest pain
- Cardiogenic pulmonary edema: to increase venous pooling, lowering cardiac preload and afterload.
Contraindications
- Children younger than 12 years of age.
- Patients currently using Viagra or similar drugs (male or female).
Precautions
- Generalized vasodilitation may cause profound hypotension and reflex tachycardia.
- Use with extreme caution in hypotensive patients.
- Use with caution in patients with EKG evidence of a right ventricular infarct.
Administration
- Oral: 0.4 mg tablet / spray sublingually, may repeat every 3-5 minutes as needed for effect.
Side Effects and Special Notes
- 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.
- Less common: orthostatic hypotension, sometimes marked.
- NOTE: Therapeutic effect is enhanced, but adverse effects are increased when patient is upright.
- Because nitroglycerin causes generalized smooth muscle relaxation, it may be effective in relieving chest pain caused by esophageal spasm.
- May be effective even in patients using paste, discs, or oral long-acting nitrate preparation.
- Patients taking Viagra or similar drugs should not be given nitroglycerin.