Page 166 - 2023 SMOG Digital

NITROGLYCERIN Lactation ?(Caution) Trade Name: 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, 1-3 minutes. Duration: 25
minutes
Indications
Labeled Indications: Treatment or prevention of angina pectoris
Contraindications
• Hypersensitivity to nitrates or any component of the formulation
• Use with phosphodiesterase-5 inhibitors (Sildenafil, Levitra, Cialis) in previous 48 hours
• Increased intracranial pressure
• Hypotension (SBP <90mmHg or >30mmHg below baseline), Bradycardia <50bpm, Tachycardia
without heart failure (>100bpm), and Right ventricular infarction.
Adverse Reactions / Precautions
• IV/IO access should be placed and SBP should be >110.
o 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
Dose and Administration: ADULT PEDIATRIC Always Reference BROSELOW Tape
Angina/coronary artery disease: Not indicated in most children, even with heart
PO: failure, as their heart failure is not usually due
• Sublingual: 0.4mg q5min max 3 doses in 15 to coronary artery disease. Could cause
min significant problems in those with depressed
• Translingual: 1 spray (0.4mg per spray) onto myocardial function. Consult Medical Direction
or under tongue q3-5min max 3 doses in 15 (if able) before use in Pediatrics.
min
CHF related Respiratory Distress:
PO:
CHF related Respiratory Distress:
PO: • 0.4mg q5min if SBP>70+2xAge
• Sublingual: 0.4mg q5min max 3 doses in 15 CHF or Cardiogenic Shock:
min as long as SBP>90 IV Drip:
• Children: 0.25 - 0.5mcg/kg/min; titrate by 1
mcg/kg/min q15-20min as tolerated (Typical
dose=1-5mcg/kg/min)(Max 10mcg/kg/min)
IV Drip: (Only used at written direction of referring
provider or consultation with medical director) • Adolescents: 5-10mcg/min (not per kg) (max
• Start at 10 mcg/min, titrate up or down to: 200mcg/min)
o 10% reduction in MAP if normotensive
o 30% reduction in MAP if hypertensive.
o Max dose: 400mcg/minute)

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