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Nitroglycerin
The major hemodynamic effects of IV nitroglycerin are decreased preload
and PAOP because of functional venodilation and mild arterial vasodilation.
It is used primarily as a preload reducer for patients with pulmonary
congestion. In higher doses, nitroglycerin displays potent coronary vasodilating
properties and beneficial effects on myocardial oxygen demand and
supply, making it the vasodilator of choice for patients with severe HF and
ischemic heart disease.
Nitroglycerin should be initiated at 5 to 10 mcg/min (0.1 mcg/kg/min) and
increased every 5 to 10 minutes as necessary and tolerated. Maintenance
doses usually range from 35 to 200 mcg/min (0.5 to 3 mcg/kg/min).
Hypotension and an excessive decrease in PAOP are important doselimiting
side effects. Some tolerance develops in most patients over 12 to
72 hours of continuous administration.