Action - Preload + After load

Reduces cardiac oxygen demand primarily by dilating blood vessels resulting in decreased blood flow (preload) to the heart from the body, decreased resistance to the heart’s pumping (after load).

Action - Blood flow to cardiac tissue?

Dilation of coronary arteries results in increased blood flow to cardiac tissue

For cardiac chest pain If patient is prescribed Nitroglycerin, the Systolic BP must remain above or equal to 110 mmHg

Indications - What if the patient is not prescribed nitro?

If patient does not have a prescription for Nitro, but appears to be having cardiac type chest pain with a SBP >110mmHg, HR >50 and <150, call EPOS for Nitro administration orders

(BEAPP) Blood Pressure( 150 or < 50)

CVS: Hypotension CNS: Dizziness, weakness, headache GI: Nausea, vomiting

Q 3 minutes maintaining target Systolic BP, 0.4mg SL (based on indication)

Onset, Peak, Duration

Onset – 1-3 minutes Peak - Unknown Duration – 30 minutes

Special Considerations

Nitroglycerin comes in forms other than spray and/or tablet, none for which are approved for EMR use. If your patient has a Nitroglycerin patch applied or is prescribed nitroglycerin tablets, it does not change the Nitroglycerin protocol.

Special Considerations - What if the pain returns after 5 minutes?

If pain is completely relieved for more than 5 minutes, you may initiate the chest pain protocol again if the pain returns. This is considered a new episode.

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DM-Nitroglycerin

Question	Answer
Class	Antianginal, Vasodilator
Action - Preload + After load	Reduces cardiac oxygen demand primarily by dilating blood vessels resulting in decreased blood flow (preload) to the heart from the body, decreased resistance to the heart’s pumping (after load).
Action - Blood flow to cardiac tissue?	Dilation of coronary arteries results in increased blood flow to cardiac tissue
Indications	For cardiac chest pain If patient is prescribed Nitroglycerin, the Systolic BP must remain above or equal to 110 mmHg
Indications - What if the patient is not prescribed nitro?	If patient does not have a prescription for Nitro, but appears to be having cardiac type chest pain with a SBP >110mmHg, HR >50 and <150, call EPOS for Nitro administration orders
Contraindications	(BEAPP) Blood Pressure(<110SBP), Erectile Dysfunction Drugs, Allergy/Hypersensitivity to Nitrates(Last 24-48hrs), Prescription(Call EPOS if not prescribed), Pulse (> 150 or < 50)
Caution	Hypotension
Side Effects	CVS: Hypotension CNS: Dizziness, weakness, headache GI: Nausea, vomiting
Dosage	Q 3 minutes maintaining target Systolic BP, 0.4mg SL (based on indication)
Onset, Peak, Duration	Onset – 1-3 minutes Peak - Unknown Duration – 30 minutes
Special Considerations - Should you shake the container?	No.
Special Considerations	Nitroglycerin comes in forms other than spray and/or tablet, none for which are approved for EMR use. If your patient has a Nitroglycerin patch applied or is prescribed nitroglycerin tablets, it does not change the Nitroglycerin protocol.
Special Considerations - What if the pain returns after 5 minutes?	If pain is completely relieved for more than 5 minutes, you may initiate the chest pain protocol again if the pain returns. This is considered a new episode.

Created by: Levelstorm3950

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