Pregnancy Classes

• VC 705.09 Chest Pain – Acute Coronary Syndrome
• VC 705.21 Shortness of Breath – Pulmonary Edema
• VC 722 Interfacility Transport of Patients with IV Heparin & Nitroglycerin
• SB 533-11 Chest Pain – Acute Coronary Syndrome
• SB 533-18 Shortness of Breath
• LA County Ref. No. 1211 Cardiac Chest Pain
• LA County Ref. No. 1214 Pulmonary Edema / CHF

• Dilates coronary arteries enhancing coronary perfusion
• Muscle relaxant acting on vascular, bronchial, uterine, and intestinal smooth muscle
• Produces venous pooling due to dilatation of arterioles and veins in the periphery
• Reduces preload and afterload which decreases the workload of the heart and thereby reduces myocardial oxygen consumption

• Angina pectoris
• Acute decompensated heart failure
• Perioperative hypertension

• Hypotension
• Hypovolemia
• Pericardial tamponade
• Severe bradycardia or tachycardia
• Recent use of phosphodiesterase inhibitor (see notes)
• Inferior wall myocardial infarction

sublingual or subingual spray: 0.4 mg at onset; repeat every 5 minutes if angina persists

1 to 3 minutes

Sublingual tablet: 5 minutes

Translingual spray: 4 to 15 minutes

25 minutes

• Increased intracranial pressure: Nitroglycerin may aggravate increased intracranial pressure in patients with neurologic injury (eg, intracranial hemorrhage, traumatic brain injury
• Hypertrophic cardiomyopathy: Avoid use in patients with hypertrophic cardiomyopathy
• Hypotension/bradycardia: Assess patient vital signs before and after administration. Nitroglycerin should not be given to a patient with a systolic blood pressure less than 100mmHg
• Concurrent use with phosphodiesterase-5 (PDE-5) inhibitors: Phosphodiesterase inhibitor medications such as Viagra/Revatio (sidenafil), Levitra (vardenafil) and Cialis (tadalafil) may have a cumulative vasodilatory effect when used in conjunction with nitroglycerin and increases tht risk of potentially fatal hypotension. If recently used (Viagra/Revatio or Levitra within 24 hours; Cialis within 48 hours), nitroglycerin may only be given by ED physician order
• Storage: Nitroglycerine is unstable and may rapidly deteriorate if exposed to air, light, or extreme temperatures
• Exposure: Administering personnel must wear gloves when handling to avoid inadvertent skin absorption
• IVPB:
  • Ventura County paramedics are not allowed to add nitroglycerin to any I solution. VC Policy 722 allows a paramedic to monitor and transport patients with a nitroglycerin infusion in progress only if they have successfully completed a training program approved by the Ventura County EMS medical director.
  • Nitroglycerin concentrations will not exceed 50mg/250mL for transport.
  • Drip rates will remain constant during transport. Do not change the rate except to turn off the infusion.
    The maximum drip rate is 50 mcg/minute.
  • Vital signs will be monitored and documented every 10 minutes

• Cardiovascular
  • Hypotension, tachycardia, syncope
• centra nervous system
  • Dizziness, headache
• gastrointestinal
  • Abdominal pain, nausea/vomiting
• other
  • Sublingual burning