II. History
- Albert Nobel stabilized Nitroglycerin for dynamite
- Some postulate that he died of Nitroglycerin toxicity
III. Preparations
IV. Indications
V. Contraindications
- Aortic Stenosis
- Pulmonary Hypertension
- Hypotension
- Phosphodiesterase Inhibitor (e.g. Viagra)
- Right sided Myocardial Infarction (seen with inferior Myocardial Infarction)
VI. Mechanism
- Relaxes vascular Smooth Muscle
- Venous Dilation (more than Nitroprusside)
- Inhibits venous return (Preload)
- Decreases intra-myocardial wall tension
- Decreases intraventricular work
- Reduces left ventricular filling pressure
- Decreases myocardial oxygen demand
- Reduces Myocardial Ischemia
- Cardiac Output
- Increased in Congestive Heart Failure
- Decreased or normal if no Heart Failure
- Inhibits venous return (Preload)
- Arterial Dilation (less than Nitroprusside)
- Relieves Angina
- Dilates large coronary arteries
- Antagonizes vasospasm
- Increases coronary collateral Blood Flow
- Increases perfusion to ischemic Myocardium
- Decreases Systemic Vascular Resistance
-
Esophageal Spasm also responds to nitrates
- Pain relief with Nitroglycerin is not always Angina
VII. Drug Interactions
-
Phosphodiesterase Inhibitors (e.g. Viagra or Sildenafil)
- Profound hypotensive reaction
- Do not use with Nitroglycerin!
- Nitrates may be used >24 hours after Sildenafil or vardenafil or >48 hours after Tadalafil
- Tissue Plasminogen Activator (Alteplase, tPA)
- IV Nitroglycerin may reduce plasma concentrations
-
Heparin
- IV Nitroglycerin may reduce Anticoagulant response
VIII. Adverse Effects
- Headache
-
Hypotension
- High risk with Aortic Stenosis, Pulmonary Hypertension, Hypotension, PDE5 Inhibitor, right-sided Myocardial Infarction
- Reduce Nitrate dose
- Administer Intravenous Fluid bolus
- Consider Atropine if Bradycardia present
- Methemoglobinemia
- Hypoxemia (Ventilation-perfusion mismatch)
IX. References
- Orman and Mattu in Herbert (2017) EM:Rap 17(7): 6-7
Images: Related links to external sites (from Bing)
Related Studies
nitroglycerin (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
NITROGLYCERIN 0.1 MG/HR PATCH | Generic | $0.66 each |
NITROGLYCERIN 0.2 MG/HR PATCH | Generic | $0.47 each |
NITROGLYCERIN 0.3 MG TABLET SL | Generic | $0.30 each |
NITROGLYCERIN 0.4 MG TABLET SL | Generic | $0.57 each |
NITROGLYCERIN 0.4 MG/HR PATCH | Generic | $0.54 each |
NITROGLYCERIN 0.6 MG/HR PATCH | Generic | $0.79 each |
NITROGLYCERIN 400 MCG SPRAY | Generic | $42.93 per gram |
NITROGLYCERIN ER 2.5 MG CAP | Generic | $0.27 each |
NITROGLYCERIN ER 6.5 MG CAP | Generic | $0.37 each |
NITROGLYCERIN LINGUAL 0.4 MG | Generic | $34.50 per gram |