I. Indications

  1. Acute Myocardial Ischemia (Angina Pectoris)
  2. Acute Myocardial Infarction
    1. Limits infarct expansion
    2. Reduces infarct size
      1. Inferior wall Myocardial Infarction
      2. Congestive Heart Failure associated with infarction
    3. Decreases vasospasm at site of Plaque rupture
  3. Congestive Heart Failure with acute pulmonary edema
  4. Hypertensive Emergency
    1. Specifically indicated for Hypertensive Emergency with acute pulmonary edema
    2. Nicardipine (or Esmolol) are indicated as first line agents in most other cases of Hypertensive Emergency

II. Preparation

  1. Mix 50 mg Nitroglycerin in 250 ml D5W

III. Dosing: Acute Myocardial Ischemia or Infarction

  1. Bolus: 12.5 to 25 mcg Nitroglycerin IV
  2. Tittration to maintenance dose
    1. Start: 10-20 mcg/min (3-6 ml/hour)
    2. Titrate: Increase 5 to 10 mcg/min every 5-10 minutes
    3. Usual dosage: 50 to 200 mcg/min (maximum 500 mcg/min)
  3. Endpoints
    1. Blood Pressure drop over 10%
    2. Adequate decrease in systemic vascular resistance
    3. Adequate fall in left ventricular filling pressure
    4. Relief of Chest Pain

IV. Dosing: Hypertensive Emergency

  1. Start: 400 mcg/minute for 2 minutes
  2. Next
    1. Decrease dose to 100 to 150 mcg/minute
    2. Observe for effect and be ready to decrease dose
    3. Cummulative bolus dose in Hypertensive Emergency approaches 400 mcg over 5 minutes

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Ontology: Parenteral form glyceryl trinitrate (C0358598)

Concepts Organic Chemical (T109) , Pharmacologic Substance(T121)
SnomedCT 346461002
English Parenteral glyceryl trinitrate, Parenteral form glyceryl trinitrate (product), Parenteral form glyceryl trinitrate, Parenteral glyceryl trinitrate (product), Parenteral glyceryl trinitrate (substance)
Spanish trinitrato de glicerilo parenteral, trinitrato de glicerilo parenteral (producto), trinitrato de glicerilo, forma farmacéutica parenteral (producto), trinitrato de glicerilo, forma farmacéutica parenteral