Nitro/Aspirin in conjunction

[Jonnyola87]

Can anyone think of an instance in which nitro and aspirin would be given together? Maybe lack of a response to one or the other. It seems that even though aspirin is a platelet inhibitor, the potential drop in bp wouldn't be significant enough to worsen the effects of nitro. Research has shown that aspirin can enhance the effect of nitro, I'm wondering if anyone has ever heard of it worsening the negative effects.

Thanks.

 

[STXmedic]

Umm... When are you not giving them together?... Unless the BP is too low for NTG, or they're allergic to ASA.

 

[Jonnyola87]

I apologize, there should be an "n't" at the end of that "would". The last sentence is the most concise question: any experience with a drop in bp associated with ASA which would contraindicate nitro? Any examples of negative interactions at all?

 

[JPINFV]

Is there a time when you wouldn't give ASA and nitro together? The only think I can think of is the cheeky "if there's a contraindication to one." Otherwise, no.

 

[STXmedic]

A quick search reveals one study from 30 years ago, with 7 subjects and 3x the dose of ASA given to most patients.

 

[Jonnyola87]

I had the same concerns with that paper (Pubmed, E. Rey, et al?) I couldn't imagine a response to ASA to such a degree that nitro would be off the table. I appreciate the responses, both.

 

[blindsideflank]

Didn't read article yet but high dose Asa can inhibit prostacyclin potentially causing vasoconstriction

 

[Jonnyola87]

From what I understand, the effects of NSAIDs would cover for the degradation of the prostacyclin pathway until transcription resumes, which is pretty rapid. So use of ASA would have to be pretty extensive to counteract prostacyclin. All in all, there shouldn't be a scenario in which vitals are so affected as to warrant holding off on another dilator (nitro).

 

[JPINFV]

From what I understand, the effects of NSAIDs would cover for the degradation of the prostacyclin pathway until transcription resumes, which is pretty rapid. So use of ASA would have to be pretty extensive to counteract prostacyclin. All in all, there shouldn't be a scenario in which vitals are so affected as to warrant holding off on another dilator (nitro).

Another dilator? ASA isn't considered a, or used for, vasodilation.

 

[Jonnyola87]

No, but prostacyclins are.

 

[FLdoc2011]

The only time I worry about NSAIDS in light of hemodynamic instability/ hypotension is there deleterious effects on renal perfusion.

 

[TheLocalMedic]

Okay... Am I missing something here? Aspirin is neither a vasoconstrictor nor vasodilator, at least at therapeutic doses.

Sounds like the OP may just simply be uneducated about what NTG and ASA are and what their effects are.

 

[SeeNoMore]

I think the key phrase is "therapeutic doses". Obviously Nitro and ASA are commonly given together without an increase in concern for hypotension. I don't think there are many real world situations in which patients are being given far higher than standard does of ASA in conjunction with nitrates. Even when given for typical reasons, standard doses of ASA may not confer a benefit over low dose ASA therapy. Out of curiosity what made you ask this? Were you just curious because of the study you read?

 

[Drax]

I had the same concerns with that paper (Pubmed, E. Rey, et al?) I couldn't imagine a response to ASA to such a degree that nitro would be off the table. I appreciate the responses, both.

The course still has us giving them in conjunction...well, one after the other.

I know M.O.N.A is standard treatment for ALS capable levels, EMT-B's go O.A.N. if I'm not mistaken.

If you're not seeing signs of improvement by the time (or 5 minutes following) you've administered your last doses (per protocol), you're supposed to treat as a heart attack, right?

 

[Medic Tim]

The course still has us giving them in conjunction...well, one after the other.



I know M.O.N.A is standard treatment for ALS capable levels, EMT-B's go O.A.N. if I'm not mistaken.



If you're not seeing signs of improvement by the time (or 5 minutes following) you've administered your last doses (per protocol), you're supposed to treat as a heart attack, right?

Hopefully you aren't just blindly putting O2 on everyone. If so your program is outdated( like most). Even nr now tests titrated o2.
We use nitro for acute coronary syndrome. Even though it and morphine don't decrease morbidity and mortality. If we suspect chest pain or pressure is cardiac in nature we give nitro in most cases .
At the BLS level you won't have 12 lead (in most cases ) or poc labs. So most all chest pains are treated as "heart attacks"or ACS.

Do you know how nitro works? What effects it has in the body? What are we trying to accomplish by administering it?

If you can't answer the above questions you shouldn't be giving it.

 

[JPINFV]

If you're not seeing signs of improvement by the time (or 5 minutes following) you've administered your last doses (per protocol), you're supposed to treat as a heart attack, right?

As an EMT, chest discomfort without obvious etiology ("I just took a baseball bat to the chest") is acute coronary syndrome until proven otherwise. There is no "If the pain goes away 5 minutes after treatment, we're good." You shouldn't be waiting 5 minutes to see if there is a response to your treatment.

Additionally, ASA is not given to relieve pain. You shouldn't expect to see the patient's pain level decrease with it because that isn't ASA's job.

 

[Drax]

retracted

 

[Drax]

As an EMT, chest discomfort without obvious etiology ("I just took a baseball bat to the chest") is acute coronary syndrome until proven otherwise. There is no "If the pain goes away 5 minutes after treatment, we're good." You shouldn't be waiting 5 minutes to see if there is a response to your treatment.

Additionally, ASA is not given to relieve pain. You shouldn't expect to see the patient's pain level decrease with it because that isn't ASA's job.

So you're saying, treat and transport without delay then?

 

[JPINFV]

So you're saying, treat and transport without delay then?

An EMT with a chest pain patient? Yes. However, in general, I can't really think of very many situations where an EMT shouldn't treat and transport since the disposition is going to be the same. There really isn't a place for EMTs to "treat and wait to see a response."

 

[Drax]

An EMT with a chest pain patient? Yes. However, in general, I can't really think of very many situations where an EMT shouldn't treat and transport since the disposition is going to be the same. There really isn't a place for EMTs to "treat and wait to see a response."

It absolutely makes more sense to move out right away. I just feel like there was a different process that I was taught...something to do with up to three separate doses, then calling for upgrade...bah nevermind. What the hell was a I taught? <_<