Nitroglycerin in 5% Dextrose (nitroglycerin)
Treatment of perioperative HTN. Control of CHF in the setting of acute MI. Treatment of angina pectoris in patients who have not responded to SL nitroglycerin and β-blockers. Induction of intraoperative hypotension.
Treatment of perioperative HTN, angina pectoris in patients who have not responded to SL nitroglycerin and β-blockers, control of CHF in the setting of acute MI and induction of intraoperative hypotension
Using Nonabsorptive Tubing:
Initial: 5mcg/min IV
Titrate: Increase by 5mcg/min at intervals of 3-5 min
If no response at 20mcg/min, may use increments of 10mcg/min and even 20mcg/min
Once some hemodynamic response is observed, dosage increments should be smaller and less frequent
Refer to PI for flow rates
Start at lower end of dosing range
Administer only via an infusion pump that can maintain a constant infusion rate
When the concentration is changed, tubing must be disconnected from patient and flushed w/ new sol before therapy is continued
Do not mix w/ any other medication
Inj: 100mcg/mL [250mL, 500mL], 200mcg/mL [250mL], 400mcg/mL [250mL, 500mL]
Pericardial tamponade, restrictive cardiomyopathy, constrictive pericarditis. Known allergy to corn or corn products. Patients taking phosphodiesterase inhibitors (eg, sildenafil, tadalafil, vardenafil) for erectile dysfunction, and riociguat.
Administration set used for infusion may affect the amount of drug delivered to patient. Several preparations of nitroglycerin inj are available, which differ in concentration and/or volume per container; use caution when switching from 1 product to another. Readily migrates into many plastics, including polyvinyl chloride (PVC) plastics; absorption by PVC tubing is increased when the tubing is long, the flow rates are low, and the nitroglycerin concentration of the sol is high. The delivered fraction of the solution's original nitroglycerin content reported as 20-60% in studies using PVC tubing; fraction varies w/ time during a single infusion, and no simple correction factor can be used. If administered through nonabsorptive tubing, doses based upon published reports will generally be too high; doses must be reduced. Some in-line IV filters also absorb nitroglycerin; avoid these filters. Do not administer through the same administration set as blood; may result in pseudoagglutination or hemolysis. May cause fluid overloading resulting in dilution of serum electrolyte concentrations, overhydration, and congested states of pulmonary edema; risk of dilutional states is inversely proportional to the electrolyte concentrations of the inj, while the risk of solute overload causing congested states w/ peripheral and pulmonary edema is directly proportional to the electrolyte concentration of the inj. Severe hypotension and shock may occur; caution in patients who may be volume depleted or are already hypotensive. Hypotension induced by nitroglycerin may be accompanied by paradoxical bradycardia and increased angina pectoris. May aggravate the angina caused by hypertrophic cardiomyopathy. Tolerance and physical dependence may occur. Consider total fluid load in patients w/ compromised function of the heart, liver, and/or kidneys. Caution in patients w/ known subclinical or overt diabetes mellitus (DM). Lab test interactions may occur. Caution in elderly.
See Contraindications. Additive vasodilating effects w/ other vasodilators. Marked symptomatic orthostatic hypotension reported when used w/ calcium channel blockers. May interfere w/ the anticoagulant effect of heparin; monitor activated PTT frequently.
PREGNANCY AND LACTATION
Category C, caution in nursing.
MECHANISM OF ACTION
Nitrate vasodilator; relaxes vascular smooth muscle and consequently dilates peripheral arteries and veins, especially the latter.
Distribution: Vd=3L/kg. Metabolism: Inorganic nitrate and 1,2- and 1,3-dinitroglycerols (metabolites). Elimination: T1/2=3 min.
Assess for hypersensitivity to organic nitrates or corn/corn products, pericardial tamponade, restrictive cardiomyopathy, constrictive pericarditis, volume depletion, hypotension, compromised heart/liver/kidney function, subclinical or overt DM, pregnancy/nursing status, and possible drug interactions.
Monitor for fluid overload, shock, aggravation of angina, tolerance, physical dependence, and other adverse reactions. Continuously monitor BP and HR; perform invasive monitoring of pulmonary capillary wedge pressure, if indicated. Monitor activated PTT frequently w/ heparin.
Inform of the risks and benefits of therapy. Advise to notify physician if pregnant/breastfeeding.
20-25°C (68-77°F). Protect from freezing.
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