Nitroglycerin / Nitrostat

- See After-Loading Agents given by Continuous Infusion;

- Discussion:
      - Angina, pulmonary HTN, venous dilatation;
      - will produce modest decr in BP;
      - has cardioprotective action by decr Preload and dilation of coronary arteries;
      - if HTN remains, may begin concomitant Nitroprusside administration;
      - agent of choice for emergency treatement of CHF, esp in pts w/ ischemic heart disease;
             - in pts w/ CHF, IV nitroglycerin & Nitroprusside exert similar beneficial hemodynamic effects;
      - IV nitroglycerin may reduce infarct size when it is used to treat CHF assoc w/ infarction & in patients with inferior wall infarction;

- Adult:
    - 1tab SL q 5min prn or SL: 0.3-0.6mg prn,
    - 2.5-9mg q8-12hr SR cap;
    - tab: 1.3-6.5mg q8-12hr;
    - topical:
            - 1-2 inches ointment to chest wall q 8hr prn (maximum 5 inches) or 2.5-12.5cm ointment q4-6hr or 1:5x20 cmsqu patch qd;
            - remove ointment or patch hs;
     - IV initially 5-10ug/min to max dose = 200ug/min; increase by increments of 5ug/kg/min, by titration;

- Peds: IV:
    - initially 1 ug/kg/min IV infusion; increase by increments of 1 ug/kg/min at 20 min interval until desired effect to max rate of 5 ug/kg/min;

- Precautions:
    - must monitor SBP (keep >90mm);
    - tolerance to nitrates will develop w/ chronic use after 1-2 weeks;
    - hence provide nitrates free period q day;
    - short acting nitrate to tid and with long acting patches remove qhs;
    - may be given with Beta blockers

- Supplied:
    - SL tabs: 0.15mg, 0.3mg, 0.4mg, 0.6mg; SR caps: 2.5 mg, 6.5 mg, 9 mg;
    - Ointment 2%; transdermal patches delivering 2.5, 5, 7.5, 10, or 15 mg/24hr;
    - Injection: 0.5 mg/ml, 0.8mg/ml, 5mg/ml

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, December 16, 2011 4:10 pm