NitroglycerinPA study guide
Known brand names include Nitrostat.
A fast-acting nitrate tablet dissolved under the tongue. It relieves an angina attack within minutes and can be taken just before activity that tends to bring on chest pain.
Known brand names include Nitrostat.
A fast-acting nitrate tablet dissolved under the tongue. It relieves an angina attack within minutes and can be taken just before activity that tends to bring on chest pain.
Labeled use. Acute relief of an attack and short-term prophylaxis before exertion.
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Labeled use. Indicated for angina caused by coronary artery disease.
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Sublingual nitroglycerin is the standard rescue drug for an acute angina attack and for prevention right before exertion; every patient with stable angina should carry it. It does not prevent attacks over the day; long-acting nitrates, beta blockers, or calcium channel blockers do that. It is never a choice for patients using PDE-5 inhibitors, and hypotension or right ventricular infarction calls for caution.
Releases nitric oxide, which raises cyclic GMP in vascular smooth muscle and relaxes it. Venous dilation dominates: blood pools in the veins, preload falls, and myocardial oxygen demand drops. It also lowers afterload and widens large coronary arteries. Onset is about 1 to 3 minutes, with peak effect by 5 minutes and effects lasting at least 25 minutes.
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The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.
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Doses come from the FDA label. Study tool, not for clinical decisions.
No labeled renal adjustment. Elimination is mainly by metabolism in the liver, blood cells, and vessel walls.
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None on the current Nitrostat label. Severe hypotension and tolerance are labeled warnings instead.
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No specific antagonist. Treat hypotension by raising central volume: lay the patient flat in a shock position with legs elevated and give IV normal saline. Epinephrine does not reverse it and is not recommended. For methemoglobinemia, give IV methylene blue 1 to 2 mg/kg unless the patient has G-6-PD deficiency.
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Published data are too limited to define a risk of birth defects or miscarriage. Animal studies at high doses showed no developmental harm.
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Not studied in breastfeeding. It is unknown whether nitroglycerin enters milk; the patient leaflet advises against breastfeeding.