Nitroglycerin
Nitroglycerin
NitroglycerinPharmacological action
Causes a relaxation of a tonus of a smooth musculation of vessels, especially venules and veins. At i.v. introduction causes fast reduction of a preload at the expense of expansion of peripheric veins. Reduces blood inflow to the right auricle, promotes pressure decrease in a small circle of a circulation, reduces an afterload, requirement of a myocardium for oxygen. Promotes redistribution of a coronary blood flow in subendocardial areas of a myocardium.
At a heart failure promotes myocardium unloading mainly at the expense of preload reduction, also reduces pressure in a small circle of a circulation.
Nitroglycerin Indications
- A stenocardia (including an astable stenocardia, an angiospastic stenocardia);
- An acute myocardial infarction;
- An acute left ventricular failure;
- A hypertensive crisis with a decompensation of warm activity;
- A controllable hypotension at operative measures.
Nitroglycerin Dosage regimen
Depending on clinical and hemodynamic indicators the dose steals up individually for each patient. At use in the conditions of a hospital treatment it is necessary to begin with a dose of 0 mg/ch, if necessary a dose gradually enlarge. The maximum dose makes 8-10 mg/ch.
At a serious stenocardia the dose makes 2-8 mg/ch (33-133 mkg/mines). During infusion it is necessary to supervise the central and endocardiac hemodynamic constantly.
At an acute left ventricular failure (fluid lungs) is prescribed by 2-8 mg/ch (33-133 mkg/mines) within 1-2 days.
At a hypertensive crisis with a decompensation of warm activity under the constant control of a BP and CARDIAC CONTRACTIONS RATES spend infusion with rate of 2-8 mg/ch (on the average 5 mg/ch).
At a controllable hypotension depending on a kind of a narcosis and demanded level of depression of a BP the dose makes 2-10 mkg/kg of mass bodies/mines under the control of an electrocardiogram, the central and endocardiac hemodynamic.
At patients with disturbance of function of a liver or kidneys it is necessary to select a dose depending on disturbance severity level.
Nitroglycerin is necessary to use for long i.v. infusions by means of automatic infusional systems in hospital conditions under constant monitoring of indicators of cardiovascular system.
Nitroglycerin is possible to enter both not dissolved at the corresponding equipment, and dissolved (it is compatible to usually used infusional solutions, such, for example, as a normal saline solution, 5 % a solution Dextrosums, 10 % a solution Dextrosums).
Rules of delution of a preparation
Quantity of active substance (Nitroglycerinum) of 10 mg of 20 mg of 30 mg of 40 mg of 50 mg
Depending on a clinical picture, indicators haemodynes and an electrocardiogram treatment can be continued within 3 days or more.
Nitroglycerin Side effect
From cardiovascular system: often in the treatment beginning headache occurrence which, as a rule, passes in some days at the further application of a preparation is possible.
Sometimes at the first application or at dose rising depression of a BP or an orthostatic hypotension that can be accompanied by reflex rising of a pulse rate, block, and also giddiness and feeling of delicacy is observed. At the expressed depression of a BP infusion should be stopped. In case the BP does not raise, it is necessary to take corresponding measures.
Seldom at the expressed depression of a BP probably depression of a coronary blood flow that leads to stenocardia advance.
In single instances are observed conditions, sometimes with a bradycardia and a sudden loss of consciousness.
From the alimentary system: seldom - a nausea, vomiting.
The other: an erubescence, allergic dermal reactions; on occasion - an exfoliative dermatitis.
At preparation application probably development of tolerance (including two-dimensional to other preparations of group of Sodium nitritums), therefore it is necessary to avoid long continuous infusions.
Contraindications
- Acute vascular insufficiency (a shock, a vascular collapse);
- A cardiogenic shock (if correction of final diastolic pressure of a left ventricle by means of an intraaortal counterpulsation or preparations with positive inotropic action is impossible);
- A toxic fluid lungs;
- The expressed arterial hypotension (a systolic BP below 90 mm hg);
- The diseases accompanied by rising of intracranial pressure;
With care it is necessary to prescribe a preparation at a hypertrophic subaortic stenosis, a chronic cardial compression, a cardiac tamponade, a stenosis of a mouth of an aorta and-or a mitral stenosis, at pressure decrease of filling of a left ventricle (for example, at an acute myocardial infarction, insufficiency of a left ventricle; it is necessary to avoid depression of a systolic BP below 90 mm hg), predilections to orthostatic reactions, at renal insufficiency, hepatic insufficiency (since the risk of development of a methemoglobinemia increases).
Pregnancy and lactemia
At pregnancy and in thoracal feeding Nitroglycerin application is possible only when the expected advantage for mother considerably exceeds possible risk for a foetus or the child.
In experimental researches it is not taped damaging action on a foetus.
Nitroglycerin Special indicatings
At Nitroglycerin application blood flow redistribution in lungs that can lead to an anoxemia is possible and cause a transient ischemia of a myocardium in patients from an ischemic heart disease.
After occurrence of first signs of intolerance it is impossible to apply a preparation repeatedly.
The solution is sterile, does not contain some preservatives. Nitroglycerin in ampoules or vials it is necessary to open in aseptic conditions directly ahead of use.
For i.v. Nitroglycerin introduction following materials are used: polyethylene, polypropylene. The infusional materials made of polyvinylchloride or Polyurethanum, reduce efficiency of a preparation as a result of absorption that it is necessary to fill with dose augmentation.
If the patient was treated earlier by organic Sodium nitritums, for example, Isosorbidum dinitrate, izosorbid-5-Monosodium nitritum big Nitroglycerin doses for achievement of desirable hemodynamic effect can be demanded.
Influence on ability to driving of motor transport and to management of mechanisms
Preparation application can cause change of rate of psychomotor reactions that can influence ability to driving of motor transport and management of mechanisms. This action appreciably amplifies at a combination to alcohol reception.
Nitroglycerin Overdosage
Symptoms: sharp depression of a BP, reflex increase of pulse, sensation of the general delicacy, giddiness and block, and also a headache, an erubescence of the person or the top half of trunk, a nausea, vomiting and a diarrhoeia. At preparation application in high doses (more than 20 mg/kg of mass of a body) are possible development of a methemoglobinemia, a cyanosis, a dyspnea; rising of intracranial pressure with cerebral symptoms is possible.
Treatment: it is necessary to watch function of the vital organs.
At the expressed arterial hypotension and-or a shock it is necessary to enlarge volume of circulating blood; in unusual cases it is possible to spend infusion of Norepinephrinum (Noradrenalinum) and-or Dopaminum. Application of Epinephrinum (adrenaline) and related substances is contraindicative.
At a methemoglobinemia depending on severity level following antidotes are recommended: Acidum ascorbinicum (1 g inside or i.v. in the form of sodium salt). Oxygen therapy, a hemodialysis, a hemotransfusion is shown.
Nitroglycerin Medicinal interaction
At simultaneous application with other vasodilators, hypotensive preparations, beta adrenoblockers, blockers of calcium channels, applied to treatment of erectile dysfunction (for example), neuroleptics, antidepressants, and also ethanol probably intensifying of hypotensive action.
Conditions and periods of storage
The preparation should be stored at temperature not above 25 C. The Period of validity - 5 years (the preparation period of validity is specified on a cardboard box and on each ampoule).
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