Nitroglycerin

Trade – Nitroquick 

Class – Antianginal agent 

MOA – Relaxes vascular smooth muscle, thereby dilating peripheral arteries and veins. This causes pooling of venous blood and decreased venous return to the heart, which decreases preload. Nitroglycerin also reduces left ventricular systolic wall tension, which decreases afterload.

Indication – Angina, ongoing ischemic chest discomfort, HTN, Myocardial Ischemia associated with cocaine intoxication. 

Contraindication – Hypotension, severe bradycardia or tachycardia, right sided MI, increased ICP, intracranial bleeding, patients taking any medications for erectile dysfunction, known sensitivity to nitrites.

Side effects – Headache, hypotension, bradycardia, lightheadedness, flushing, cardiovascular collapse, methemoglobinemia

Dosing Adult

Sublingual tablets/translingual spray 0.4mg at 5 min intervals for a max of 3 doses

Ointment 2% topical apply 1-2 inches of paste over the chest wall 

IV infusion 5mcg/min may increase rate by 5-10mcg/min every 5 – 10 mins as needed

Pedi

IV infusion – 0.25-0.5 mcg/kg/min titrate up to max dose of 5 mcg/kg/min