Page 154 - 2026 SMOG

NITROGLYCERIN (NITROMIST/NITROSTAT)
Class/Mechanism of Action
• Antianginal Agent, Vasodilator
Induces smooth muscle relaxation and vasodilation of peripheral veins and arteries and
coronary arteries, thus improving collateral blood flow to ischemic regions of the myocardium.
Reduces cardiac oxygen demand by decreasing preload.
˚ Onset of action—Sublingual tablet and spray: 1–3min; Duration: 25min
Indications
• Labeled Indications
˚ Treatment or prevention of angina pectoris
Contraindications
• Hypersensitivity to nitrates or any component of the formulation
• Use of phosphodiesterase-5 inhibitors (Sildenafil, Levitra, Cialis) in the previous 48hrs.
• Increased intracranial pressure
• Hypotension (SBP <90mmHg or >30mmHg below baseline), Bradycardia <50 bpm,
tachycardia without heart failure (>100 bpm), and right ventricular infarction
Adverse Reactions/Precautions
• IV/IO access should be placed, and SBP should be >110. Use cautiously in cases of
chest pain unless inferior wall/right-ventricular MI can be ruled out by ECG prior to
administration
• Can cause severe hypotension with associated paradoxical bradycardia and increased angina
• Use with caution in volume-depleted patients.
• Do not use for inferior wall MI and suspected right ventricular involvement.
• Pregnancy: Category C
• Lactation: Yes, use caution
Dose/Administration
PEDIATRIC
ADULT
(Always reference Broselow Tape)
Angina/Coronary Artery Disease Not indicated in most children, even with
• PO heart failure, as their heart failure is not
˚ Sublingual: 0.4mg q5min (max dose: usually due to coronary artery disease. It
3 doses in 15min)
could cause significant problems in those
˚ Translingual: 1 spray (0.4mg/spray) onto with depressed myocardial function. Consult
or under the tongue q3–5min (max dose:
Medical Direction (if able) before use in
3 doses in 15min) Pediatrics.
CHF Related Respiratory Distress CHF or Cardiogenic Shock/Hypertensive
• PO Crisis/Myocardial Ischemia
˚ Sublingual: 0.4mg q5min (max dose: • IV Drip
Infants/Children: 0.25–0.5mcg/kg/min;
˚
3 doses in 15min as long as SBP >90)
titrate by 1mcg/kg/min q15–20min as
tolerated, to desired effect
˚ Adolescents: 5–10mcg/min (not per kg)
Maximum dose: increase to
■
200mcg/min, as tolerated, to desired
effect
146 • MEDICATIONS