Nitroglycerin SL should be administered to an ACS patient at a dose of how many sprays, every how many minutes, until what condition?

• A. One spray, every 3 minutes, SBP less than 100
• B. Two sprays, every 5 minutes, SBP less than 90
• C. One spray, every 1 minute, SBP less than 110
• D. Two sprays, every 3 minutes, SBP less than 100

Answer: (A)

The key idea is using a small, rapid-acting nitrate dose with careful blood pressure monitoring. Nitroglycerin given sublingually is 0.4 mg per spray. Start with one spray and reassess after about 3 minutes. If chest pain persists and the patient’s systolic blood pressure remains safe (typically still ≥ 100 mmHg), you may repeat the dose, up to a total of three sprays. The critical safety rule is to stop administering if systolic blood pressure drops below 100 mmHg, since nitrates can cause significant hypotension. Monitoring BP before each dose is essential to prevent dangerous drops in pressure. This approach—one spray, then another at 3-minute intervals if needed, and stopping when SBP falls below 100 mmHg—best matches the recommended practice.