Medication 7-636 - Nitroglycerin (Nitrostat, Nitrolingual, Tridil)

CMH EMS & MIH Protocols

Scope of Practice:

• Advanced Emergency Medical Technician
• Registered Nurse
• Paramedic
• Community Paramedic

Route(s):

• IO, IV, PO, SL, Topical

Pharmacodynamics (class and mechanism of action):

• Nitrate vasodilator. (Smooth muscle relaxant. Dilates coronary and systemic arteries.).

Pharmacokinetics:

• Half-life: 1-4 hours.
• Onset time:
• IV: Immediate.
• PO: 20-45 minutes.
• SL: 1-3 minutes.
• Topical: 30 minutes.
• Peak action time: Unknown.
• Duration of action:
• IV: 3-5 minutes.
• PO: 3-8 hours.
• SL: 30-60 minutes.
• Topical: 2-24 hours.

• Peak	5	10	15	20	25	30	35	40	45	50	minutes
  Duration	5	10	15	20	25	30	35	40	45	50	minutes

Dosing:

• Refer to specific protocol(s) below for dose(s).

Indications:

• Protocol 2-220 - Chest Pain / Suspected Cardiac Event.
• Protocol 2-528 - Hypertension.
• Protocol 2-726 - Pulmonary Edema.

Contraindications:

• Age less than 12 yrs.
• Hypotension.
• Severe Bradycardia or Tachycardia.
• ICP.
• Patients taking erectile dysfunction medications: Phosphodiesterase inhibitor within 48 hours (i.e. Viagra, Levitra, Cialis).

Pregnancy Risk Factor:

• Category C
• Risk not ruled out: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. FDA requires a relatively large amount of high-quality data on a pharmaceutical for it to be defined as Pregnancy Category A. As a result of this, many drugs that would be considered Pregnancy Category A in other countries are allocated to Category C by the FDA.

Potential Incompatibilities:

• None.

Precautions and Adverse Effects:

• Patients with inferior wall MI and right ventricular involvement may have more pronounced hemodynamic response. Preferred to have IV access prior to administration. Monitor blood pressure.
• Drug must be protected from light.
• Expires quickly once bottle is opened.
• May cause syncope, headache, dizziness, hypotension, Bradycardia, lightheadedness, and/or flushing.

Antidote:

• None.

Controlled Substance Information:

• Not a scheduled drug
• The DEA and FDA have not identified this drug with a schedule classification.
• DEA number: NA.
• Narcotic: No.
• Street names: NA.

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Polk, Hickory, Cedar, & St Clair County EMS Protocols is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.