NO drugs

Question 1

Nitric Oxide (INOMAX) Type & indication

Answer 1

Acute Coronary Syndromes (angina), Primary Pulmonary Hypertension

Question 2

Nitric Oxide (INOMAX) MOA

Answer 2

covalent modification of proteins

Question 3

Nitric Oxide (INOMAX) Route of Admin

Answer 3

inhalation, use fitted mask

Question 4

Nitric Oxide (INOMAX) Adverse Effects

Answer 4

vasodilation

Question 5

Nitric Oxide (INOMAX) Notes

Answer 5

only direct time we give NO to people!

Question 6

Nitroglycerine Type & indication

Answer 6

Pulmonary Artery Hypertension

Question 7

Nitroglycerine MOA

Answer 7

NO donor

Question 8

Nitroglycerine Drug Action/Pd

Answer 8

first-pass effect is significant which is why we have pts take it under the tongue (avoid oral route)

Question 9

Nitroglycerine Route of Admin

Answer 9

sublingual

Question 10

Nitroglycerine Adverse Effects

Answer 10

hypotension

Question 11

Nitroglycerine Drug interactions

Answer 11

viagra (sildenafil)–could cause lethal hypotensive episode

Question 12

Nitroglycerine Notes

Answer 12

note isosorbide dinitrate (orally okay) & nitroglycerin

Question 13

Hydralazine Type & indication

Answer 13

Hypertension

Question 14

Hydralazine MOA

Answer 14

NO donor

Question 15

Hydralazine Route of Admin

Answer 15

oral

Question 16

Hydralazine Adverse Effects

Answer 16

headache, nausea, vomiting, hypotension

Question 17

Sildenafil (Viagra) Type & indication

Answer 17

Hypertension, Erectile Dysfunction

Question 18

Sildenafil (Viagra) MOA

Answer 18

PDE inhibitor (increase cGMP), cGMP causes muscle relaxation

Question 19

Sildenafil (Viagra) Route of Admin

Answer 19

oral

Question 20

Sildenafil (Viagra) Adverse Effects

Answer 20

hypotension, drug interactions

Question 21

Sildenafil (Viagra) Drug interactions

Answer 21

nitroglycerine, nitrates for anti-anginal situations

Question 22

Sildenafil (Viagra) Notes

Answer 22

originally a heart drug (coronary vasodilation)

Question 23

L-Arginine Type & indication

Answer 23

Acute Coronary Syndromes, Vascular disease

Question 24

L-Arginine MOA

Answer 24

NO donor

Question 25

L-Arginine Route of Admin

Answer 25

oral

Question 26

L-Arginine Adverse Effects

Answer 26

hypotension

Question 27

NO Vascular Effects

Answer 27

inhibitor of white cell adhesion to endothelial surface (selectins, integrins) is protective against reperfusion injury

Question 28

NO Respiratory Effects

Answer 28

improves cardiopulmonary function in adults with pulmonary HTN, and kids with ARDS b/c it is a bronchodilator

Question 29

NO Septic Shock

Answer 29

Bacterial LPS activate NOS-2 resulting in hypotension, shock and possible death (yikes). You need to use an inhibitor here like L-NMMA.

Question 30

NO Atherosclerosis

Answer 30

Vascular plaques & endothelial damage result in impaired NO formation from endothelial cells. Decreased release of NO leads to vascular defects and increased cell proliferation.

Question 31

NO Platelets

Answer 31

NO inhibits release of anti-plasmin from platelets (so enhance fibrinolysis indirectly), also inhibits platelet adhesion, activation, aggregation. No activation, no release of vasoconstrictors like serotonin and thromboxane.

Question 33

NO Organ Transplant

Answer 33

cytoprotective in organ transplant, preventing cellular and platelet adhesion, reduced graft atherosclerosis. Excessive NO may promote graft rejection.

Question 34

NOS-1

Answer 34

nNOS (neuronal), constitutive expression, neuronal and epithelial cells, requires Ca2+

Question 35

NOS-2

Answer 35

iNOS (inducible), inducible “bad” one, at macrophages and smooth muscle, does NOT require Ca2+

Question 36

NOS-3

Answer 36

eNOS (endothelial), constitutive expression, endothelial cells, requires Ca2+

Question 37

Inhibitors of NOS

Answer 37

Scavengers of NO like Heme

Question 38

L-arginine derivatives: L-NMMA, LNAME

Answer 38

Inhibitors of arginine binding to NOS