Nitroglycerin

Provider Level

EMT/AEMT/RN/Paramedic

Class

Vasodilator, Nitrate

Mechanism of Action

Relaxes vascular smooth muscle leading to dilation of both venous and arterial beds, decreasing preload and afterload, and reducing myocardial oxygen demand. Also improves coronary collateral circulation.

Indications

Ischemic chest pain (angina, acute myocardial infarction), cardiogenic pulmonary edema, congestive heart failure.

Contraindications

Hypotension, recent use of phosphodiesterase-5 (PDE-5) inhibitors for erectile dysfunction or pulmonary hypertension, right ventricular infarction, severe anemia, increased intracranial pressure.

Routes

SL, IV, Dermal

Onset / Duration

Onset: 1-3 minutes (SL). Duration: 20-30 minutes (SL).

Adverse Effects

Headache, hypotension, dizziness, syncope, reflex tachycardia, flushing, nausea, vomiting.

Precautions & Interactions

Closely monitor blood pressure and heart rate before and after administration. Be prepared to treat severe hypotension with positioning and IV fluids. Use caution in volume-depleted patients.

Special Considerations

Obtain a 12-lead ECG prior to administration if possible to rule out right ventricular infarction. Have the patient sit or lie down during administration to prevent syncope.