Pharm
Nitroglycerin Drip
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Nitroglycerin Drip
, Intravenous Nitroglycerin, Nitroglycerin Infusion
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
Preparation
Mix 50 mg
Nitroglycerin
in 250 ml D5W
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
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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