Usual Adult Dose for Myocardial Infarction INTRAVENOUS SOLUTION: 5 mcg/min continuous IV infusion via non-absorptive tubing; increase by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then by 10 or 20 mcg/min if needed
Can nitroglycerin be used to treat acute myocardial infarction?
Abstract. Acute myocardial infarction (MI) and its sequelae are leading causes of morbidity and mortality worldwide. Nitroglycerin (glyceryl trinitrate [GTN]) remains a first-line treatment for angina pectoris and acute MI. Nitroglycerin achieves its benefit by giving rise to nitric oxide (NO), which causes vasodilation and increases blood flow ...
Does long-term nitrate therapy after acute myocardial infarction improve prognosis?
low-dose intravenous (iv) nitroglycerin (ntg) infusion for the first 48 h after acute mi, titrated to lower mean blood pressure by 10% to 30%, but not below 80 mmhg, has been shown to be safe, to improve hemodynamics, and to decrease infarct size, infarct expansion, complications, and deaths in a prospective, randomized, single-blind study of 310 …
How does nitroglycerin affect cardiomyocyte viability following ischemia?
· Usual Adult Dose for Myocardial Infarction. INTRAVENOUS SOLUTION: 5 mcg/min continuous IV infusion via non-absorptive tubing; increase by 5 mcg/min every 3 to 5 minutes …
How do you treat angina pectoris with nitroglycerin?
For example, 300 mg of clopidogrel is administered orally for those patients that are receiving thrombolysis and 600 mg of clopidogrel is administerted orally in case where there is …
How much nitroglycerin should I administer?
Adults—1 or 2 packets placed under the tongue at the first sign of an angina attack. 1 packet may be used every 5 minutes as needed, for up to 15 minutes. Do not take more than 3 packets in 15 minutes. Children—Use and dose must be determined by your doctor.
What is nitrostat 0.4 mg used for?
This medication is used to relieve chest pain (angina) in people that have a certain heart condition (coronary artery disease). It may also be used before physical activities (such as exercise, sexual activity) to help prevent chest pain. Nitroglycerin belongs to a class of drugs known as nitrates.
How much nitroglycerin is too much?
Do not take more than 3 nitroglycerin tablets over 15 minutes. If you take this medicine often to relieve symptoms of angina, your doctor or health care professional may provide you with different instructions to manage your symptoms.
How many doses of nitroglycerin nitrostat can be given before calling EMS?
Most of us were taught to recommend taking one SL NTG every 5 minutes...and call 911 if there's no relief after the THIRD dose. But the guidelines now say to call 911 if there's no relief 5 minutes after just ONE dose.
What doses does nitroglycerin come in?
NITROSTAT is supplied as white, round, flat-faced tablets in 3 strengths (0.3 mg, 0.4 mg, and 0.6 mg) in bottles containing 100 tablets each, with color-coded labels, and in color-coded Patient Convenience Packages of 4 bottles of 25 tablets each.
How much does nitroglycerin lower BP?
At 5 and 10 min after sublingual nitroglycerin, mean reduction of mean arterial blood pressure by 12.3 and 16.3% was achieved.
What happens if you take to much nitroglycerin?
An overdose of nitroglycerin can be fatal. Overdose symptoms may include a throbbing headache, confusion, pounding heartbeats, vision problems, vomiting, bloody diarrhea, sweating, clammy skin, blue lips, weak or shallow breathing, loss of movement, seizure, or fainting.
When do you give nitroglycerin EMT?
For EMS providers, typical nitroglycerin indications include chest pain or discomfort associated with angina pectoris or suspected acute myocardial infarction, as well as pulmonary edema with hypertension.
Do you give aspirin or nitroglycerin first?
This study hypothesizes that the order of administering these drugs is important, and giving aspirin several minutes before nitroglycerin can lead to a better patient outcome and theoretically can help in re-vascularization.
What are the 5 contraindications of nitroglycerin?
The contraindications of nitroglycerine therapy include:Allergic reactions to nitroglycerin are extremely rare, but reports do exist. ... Known history of increased intracranial pressure, severe anemia, right-sided myocardial infarction, or hypersensitivity to nitroglycerin are contraindications to nitroglycerin therapy.More items...•
When should I withhold nitroglycerin?
"Nitrates should not be given to patients with hypotension, marked bradycardia or tachycardia, RV infarction, or 5'phosphodiesterase inhibitor use within the previous 24 to 48 hours."
What is the appropriate route for nitroglycerin administration by the EMT?
To administer a sublingual (SL) medication, place the pill or direct the spray between the underside of the tongue and the floor of the oral cavity. The medication is rapidly absorbed through the mucous membranes of the mouth and blood vessels of the tongue. The most common drug given by this route is nitroglycerin.
What is the treatment for acute myocardial infarction?
Nitroglycerin (glyceryl trinitrate [GTN]) remains a first-line treatment for angina pectoris and acute MI. Nitroglycerin achieves its benefit by giving rise to nitric oxide (NO), which causes vasodilation and increases blood flow to ...
Does Nitroglycerin increase blood flow?
Nitroglycerin achieves its benefit by giving rise to nitric oxide (NO), which causes vasodilation and increases blood flow to the myocardium. However, continuous delivery of GTN results in tolerance, limiting the use of this drug.
Is nitroglycerin used for angina pectoris?
Acute myocardial infarction (MI) and its sequelae are leading causes of morbidity and mortality worldwide. Nitroglycerin (glyceryl trinitrate [GTN]) remains a first-line treatment for angina pectoris and acute MI.
Usual Adult Dose for Angina Pectoris
INTRAVENOUS SOLUTION: 5 mcg/min continuous IV infusion via non-absorptive tubing; increase by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then by 10 or 20 mcg/min if needed Comments: -Starting doses of 25 mcg/min or higher have been used with polyvinyl chloride (PVC) tubing. -Lower concentrations increase potential dosing precision and volume to be delivered; consider patient fluid requirements and expected infusion duration when selecting an appropriate dilution. Use: Treatment of angina pectoris in patients who have not responded to sublingual nitroglycerin and beta-blockers. LINGUAL SPRAY: 1 to 2 sprays (0.4 to 0.8 mg) on or under tongue every 5 minutes as needed, up to 3 sprays in 15 minutes; if pain persists after maximum dose, prompt medical attention is recommended Comments: -Administer while sitting due to rapid onset. -Advise patient not to inhale or swallow this medication. Use: Acute relief of an anginal attack. SUBLINGUAL TABLET: 0.3 to 0.6 mg sublingually or in the buccal pouch every 5 minutes as needed, up to 3 doses in 15 minutes; if pain persists after maximum dose, prompt medical attention is recommended Comments: -Administer while sitting down due to rapid onset. -Advise patient not to chew or swallow this medication. Use: Acute relief of an anginal attack..
Usual Adult Dose for Angina Pectoris Prophylaxis
LINGUAL SPRAY: 1 to 2 sprays (0.4 to 0.8 mg) on or under tongue 5 to 10 minutes prior to activity that might precipitate an acute attack Comments: -Administer while sitting due to rapid onset. -Advise patient not to inhale or swallow this medication. SUBLINGUAL TABLET: 0.3 to 0.6 mg sublingually or in the buccal pouch 5 to 10 minutes prior to engaging in activities that might precipitate an acute attack Comments: -Administer while sitting due to rapid onset. -Advise patient not to chew or swallow this medication. TOPICAL OINTMENT: 1/2 inch (7.5 mg) topically upon rising and 1/2 inch (7.5 mg) 6 hours later; titrate as needed and tolerated Comments: -Clinical trial doses have ranged from 1/2 to 2 inches (7.5 to 30 mg) applied to 36 square inches of truncal skin. -Ointment should be applied to a dry and hairless area of the trunk. TRANSDERMAL PATCH: 0.2 to 0.4 mg/hr patch applied topically once a day for 12 to 14 hours per day; titrate as needed and tolerated up to 0.8 mg/hr Comments: -Patch should be applied to a dry and hairless area of the upper arm or body; rotate application sites to avoid skin irritation. -Doses between 0.4 and 0.8 mg/hr have shown continued effectiveness for 10 to 12 hours daily for at least 1 month of intermittent administration. EXTENDED RELEASE CAPSULE: 2.5 to 6 mg orally 3 to 4 times a day; titrate as needed and tolerated Comments: -Subjects were titrated up to 26 mg four times a day in one clinical trial..
Usual Adult Dose for Myocardial Infarction
INTRAVENOUS SOLUTION: 5 mcg/min continuous IV infusion via non-absorptive tubing; increase by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then by 10 or 20 mcg/min if needed Comments: -Starting doses of 25 mcg/min or higher have been used with polyvinyl chloride (PVC) tubing. -Lower concentrations increase potential dosing precision and volume to be delivered; consider patient fluid requirements and expected infusion duration when selecting an appropriate dilution. Use: Control of congestive heart failure in the setting of acute myocardial infarction..
Usual Adult Dose for Hypertension
INTRAVENOUS SOLUTION: 5 mcg/min continuous IV infusion via non-absorptive tubing; increase by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then by 10 or 20 mcg/min if needed Comments: -Starting doses of 25 mcg/min or higher have been used with polyvinyl chloride (PVC) tubing. -Lower concentrations increase potential dosing precision and volume to be delivered; consider patient fluid requirements and expected infusion duration when selecting an appropriate dilution. Uses: -Treatment of perioperative hypertension. -Induction of intraoperative hypotension..
Usual Adult Dose for Anal Fissure and Fistula
RECTAL OINTMENT: 1 inch of ointment (375 mg of ointment equivalent to 1.5 mg of nitroglycerin) intra-anally every 12 hours for up to 3 weeks Comments: -A finger covering such as plastic wrap, a disposable surgical glove, or a finger cot should be placed on the finger to apply ointment. -Insert finger no further than first finger joint and apply around side of anal canal; if unable to insert finger due to pain, apply directly to outside of anus. Use: Treatment of moderate to severe pain associated with chronic anal fissure..
Precautions
Safety and efficacy have not been established in patients younger than 18 years. Consult WARNINGS section for additional precautions.
Other Comments
Administration advice: The manufacturer product information should be consulted. Storage requirements: The manufacturer product information should be consulted. Reconstitution/preparation techniques: The manufacturer product information should be consulted. IV compatibility: -IV solution: Do not add supplementary medication. Monitoring: Many cases may require invasive monitoring of pulmonary capillary wedge pressure..
How many trials have compared the effect of IV TNG?
randomized trials (3-9) have compared the effect of IV TNG
How many pafients are in the IV TNG group?
al (4), who found that 39% of 31 pafients in the IV TNG group
What is IV TNG?
Intravenous nitroglycerin (IV TNG) has been increasingly used in the setting of acute myocardial
Is nitroglycerin oral or sublingual?
Sublingual and oral forms of nitroglycerin are well estab
Does TNG require morphine?
of patients receiving IV T NG required morphine for pain control
Is TNG safe for myocardial infarction?
TNG in low dosage is safe in the setting of acute myocardial infarction and modestly effective in
Why is nitrate used in myocardial infarction?
Nitroglycerin and nitrates have long been contraindi-cated in the treatment of acute myocardial infarction because of the possibility of an undesirable decrease in arterial blood pressure and the induction of cardiogenic shock.
Is nitroglycerin good for hypertension?
— Nitroglycerin, therefore, seems to be applicable even in patients with acute and marked arterial hypertension.
Does nitroglycerin help with myocardial infarction?
Nowadays nitroglycerin seems to be indicated at least in subgroups of patients with acute myocardial infarction. Intravenous nitroglycerin reduce left ventricular filling pressure up to 40% within several minutes. The effect is most pronounced if filling pressure is elevated.
Does atropine help with bradycardia?
Even bradycardia seems to be improved, since the use for atropine was only half that for the control patients. These results provide evidence that nitroglycerin and nitrates appear to be indicated in patients with acute myocardial infarction, especially in those with left ventricular failure.
Does nitroglycerin help with pulmonary edema?
Nitroglycerin seems to be the drug of choice in acute pulmonary edema, because of its internal bloodletting effect. Following sublingual nitroglycerin, left ventricular filling pressure decreased within 3–5 minutes in conjunction with clinical improvement of the patient.
Does nitroglycerin reduce mortality?
Preliminary results showed early mortality to be reduced in patients receiving nitroglycerin; The rate of reinfarction also was lower. The incidence of angina pectoris 1 1/2 years after the infarct, however, was higher in patients receiving nitroglycerin therapy initially. Following infarct size reduction more ischemic myocardium remains, possible indication for further therapy such as bypass surgery. The improvement in myocardial ischemia seems to be the reason for the reduction in ventricular ectopic beats during treatment. The need for lidocaine was markedly reduced. Even bradycardia seems to be improved, since the use for atropine was only half that for the control patients. These results provide evidence that nitroglycerin and nitrates appear to be indicated in patients with acute myocardial infarction, especially in those with left ventricular failure.
