For a patient exhibiting mod/severe signs and symptoms of CHF/pulmonary edema with a systolic BP of 188/90, what is the correct nitroglycerin dose?

For a patient exhibiting mod/severe signs and symptoms of CHF/pulmonary edema with a systolic BP of 188/90, what is the correct nitroglycerin dose?

• A. 0.4 mg SL
• B. 1.2 mg SL
• C. 0.4 mg IV
• D. 0.8 mg SL

Answer: (D)

In acute CHF with pulmonary edema, nitroglycerin helps by pulling fluid away from the lungs and reducing the workload on the heart through vasodilation. When blood pressure is significantly elevated, using a higher sublingual dose can achieve faster and stronger vasodilation, which more quickly lowers LV filling pressures and reduces pulmonary congestion. Two 0.4 mg sublingual tablets (total 0.8 mg) provide a more robust effect than a single 0.4 mg dose, which is why 0.8 mg is chosen here. Recheck blood pressure and symptoms after about 3–5 minutes and repeat per protocol if the pressures remain adequate and symptoms persist. Stop if the systolic BP falls below about 100 mmHg or if there are contraindications (for example recent phosphodiesterase inhibitor use).

In acute CHF with pulmonary edema, nitroglycerin helps by pulling fluid away from the lungs and reducing the workload on the heart through vasodilation. When blood pressure is significantly elevated, using a higher sublingual dose can achieve faster and stronger vasodilation, which more quickly lowers LV filling pressures and reduces pulmonary congestion. Two 0.4 mg sublingual tablets (total 0.8 mg) provide a more robust effect than a single 0.4 mg dose, which is why 0.8 mg is chosen here. Recheck blood pressure and symptoms after about 3–5 minutes and repeat per protocol if the pressures remain adequate and symptoms persist. Stop if the systolic BP falls below about 100 mmHg or if there are contraindications (for example recent phosphodiesterase inhibitor use).