NITROGLYCERIN

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NITROGLYCERIN

• EMERGENCY MEDICAL TECHNICIAN - BASIC

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Description

• Class
• Nitrate
• Description
• Nitroglycerin is a potent smooth muscle relaxant
  used in the treatment of angina pectoris.

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Mechanism of Action

• Nitroglycerin is a rapid smooth muscle relaxant
  that reduces cardiac work and dilates the
  coronary arteries. As a result there is increased
  coronary blood flow and improved perfusion to the
  myocardium. Nitroglycerin also causes
  vasodilation decreasing the preload on the heart.
  Decreased preload leads to decreased cardiac
  work.

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Indications

• Indications
• Ischemic Chest Pain

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Contraindications

• Contraindications
• BPlt100mm Hg
• Pt. Has already taken maximum dose of three doses
  (1.2mg)
• Pt who has used E.D.(Viagra, Cialis, Levitra)
  within 4 hours
• E.D. drugs are used to treat pulmonary
  hypertension so woman may also be on them

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Contraindications

• Pt who has used cocaine in last 24 hours
• Pt. who may have increase intracanial pressure

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Nitroglycerin

• Dose
• 0.4mg sublingual
• Tablet
• May repeat at 5 minute intervals up to 3 doses
  (1.2mg)

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Administration

• Nitroglycerin should be administered
  sublingually.
• Care should be taken to ensure that tablet is not
  swallowed, but rather allowed to dissolve.

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Nitroglycerin

• Side Effects
• Hypotension
• Reflex Tachycardia
• Headache
• Dizziness
• Weakness
• Dry mouth
• Nausea vomiting

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Nitroglycerin

• Comments
• Most effective when Pt is sitting
• If tablet form - Protect potency
• Store in original brown bottle
• Keep tightly sealed
• Protect from light, air, heat
• Secure new supply every 4 - 6 months

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Nitroglycerin

• Potent Nitroglycerin
• Headache
• Burning sensation under tongue

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Region IV

• Standard Operating Guidelines (SOG)

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Suspected Cardiac Patient with Chest Pain

• BLS - Provide initial medical care
• Special considerations
• Carefully inquire of patients use of Viagra
  (sildenafil citrate), Cialis, Levitra, within 4
  hours or the use of Cocaine within the past 24
  hours. May potentiate the effects of nitrates.

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Suspected Cardiac Patient with Chest Pain

• Baby Aspirin 4-81mg tablets (324mg) chewed and
  swallowed unless contraindicated.
• May assist the patient with their own
  NITROGLYCERINE if patient has not taken the
  maximum dose NITROGLYCERINE, assist the patient
  to administer 1 table of ITROGLYCERINE 0.4mg SL
  if the BPgt100mg Hg systolic. The NITROGLYCERINE
  may be repeated with the guidance of medical
  control. Maintain the patient in a reclining
  position.

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Suspected Cardiac Patient with Chest Pain

• 3. Contact Medical Control prior to providing
  additional treatment for patients with chest pain
  who is lt18 yrs of age.

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Additional Information

• AS WITH ANY MEDICATION REASSESS VITAL SIGNS AFTER
  ADMINISTRATION.
• Blood pressure should always be monitored during
  nitroglycerin administration
• REASSESS PATIENT FREQUENTLY FOR ANY CHANGE.

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Resources Used

• Region IV Standard Operating Guidelines (SOG)
• Brady Prehospital Emergency Pharmacology Fifth
  Edition