II. Indications
- Acute Myocardial Ischemia (Angina Pectoris)
- Acute Myocardial Infarction
- Limits infarct expansion
- Reduces infarct size
- Inferior wall Myocardial Infarction
- Congestive Heart Failure associated with infarction
- Decreases vasospasm at site of Plaque rupture
- Congestive Heart Failure with acute pulmonary edema
-
Hypertensive Emergency
- Specifically indicated for Hypertensive Emergency with acute pulmonary edema
- Nicardipine (or Esmolol) are indicated as first line agents in most other cases of Hypertensive Emergency
III. Preparation
- Mix 50 mg Nitroglycerin in 250 ml D5W
IV. Dosing: Acute Myocardial Ischemia or Infarction
- Bolus: 12.5 to 25 mcg Nitroglycerin IV
- Tittration to maintenance dose
- Start: 10-20 mcg/min (3-6 ml/hour)
- Titrate: Increase 5 to 10 mcg/min every 5-10 minutes
- Usual dosage: 50 to 200 mcg/min (maximum 500 mcg/min)
- Endpoints
- Blood Pressure drop over 10%
- Adequate decrease in systemic vascular resistance
- Adequate fall in left ventricular filling pressure
- Relief of Chest Pain
V. Dosing: Hypertensive Emergency
- Start: 400 mcg/minute for 2 minutes
- Next
- Decrease dose to 100 to 150 mcg/minute
- Observe for effect and be ready to decrease dose
- Cummulative bolus dose in Hypertensive Emergency approaches 400 mcg over 5 minutes
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| Concepts | Organic Chemical (T109) , Pharmacologic Substance (T121) |
| SnomedCT | 346461002 |
| English | Parenteral glyceryl trinitrate, Parenteral form glyceryl trinitrate (product), Parenteral form glyceryl trinitrate, Parenteral glyceryl trinitrate (product), Parenteral glyceryl trinitrate (substance) |
| Spanish | trinitrato de glicerilo parenteral, trinitrato de glicerilo parenteral (producto), trinitrato de glicerilo, forma farmacéutica parenteral (producto), trinitrato de glicerilo, forma farmacéutica parenteral |
