NO drugs Flashcards
Nitric Oxide (INOMAX) Type & indication
Acute Coronary Syndromes (angina), Primary Pulmonary Hypertension
Nitric Oxide (INOMAX) MOA
covalent modification of proteins
Nitric Oxide (INOMAX) Route of Admin
inhalation, use fitted mask
Nitric Oxide (INOMAX) Adverse Effects
vasodilation
Nitric Oxide (INOMAX) Notes
only direct time we give NO to people!
Nitroglycerine Type & indication
Pulmonary Artery Hypertension
Nitroglycerine MOA
NO donor
Nitroglycerine Drug Action/Pd
first-pass effect is significant which is why we have pts take it under the tongue (avoid oral route)
Nitroglycerine Route of Admin
sublingual
Nitroglycerine Adverse Effects
hypotension
Nitroglycerine Drug interactions
viagra (sildenafil)–could cause lethal hypotensive episode
Nitroglycerine Notes
note isosorbide dinitrate (orally okay) & nitroglycerin
Hydralazine Type & indication
Hypertension
Hydralazine MOA
NO donor
Hydralazine Route of Admin
oral
Hydralazine Adverse Effects
headache, nausea, vomiting, hypotension
Sildenafil (Viagra) Type & indication
Hypertension, Erectile Dysfunction
Sildenafil (Viagra) MOA
PDE inhibitor (increase cGMP), cGMP causes muscle relaxation
Sildenafil (Viagra) Route of Admin
oral
Sildenafil (Viagra) Adverse Effects
hypotension, drug interactions
Sildenafil (Viagra) Drug interactions
nitroglycerine, nitrates for anti-anginal situations
Sildenafil (Viagra) Notes
originally a heart drug (coronary vasodilation)
L-Arginine Type & indication
Acute Coronary Syndromes, Vascular disease
L-Arginine MOA
NO donor
L-Arginine Route of Admin
oral
L-Arginine Adverse Effects
hypotension
NO Vascular Effects
inhibitor of white cell adhesion to endothelial surface (selectins, integrins) is protective against reperfusion injury
NO Respiratory Effects
improves cardiopulmonary function in adults with pulmonary HTN, and kids with ARDS b/c it is a bronchodilator
NO Septic Shock
Bacterial LPS activate NOS-2 resulting in hypotension, shock and possible death (yikes). You need to use an inhibitor here like L-NMMA.
NO Atherosclerosis
Vascular plaques & endothelial damage result in impaired NO formation from endothelial cells. Decreased release of NO leads to vascular defects and increased cell proliferation.
NO Platelets
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.
NO Organ Transplant
cytoprotective in organ transplant, preventing cellular and platelet adhesion, reduced graft atherosclerosis. Excessive NO may promote graft rejection.
NOS-1
nNOS (neuronal), constitutive expression, neuronal and epithelial cells, requires Ca2+
NOS-2
iNOS (inducible), inducible “bad” one, at macrophages and smooth muscle, does NOT require Ca2+
NOS-3
eNOS (endothelial), constitutive expression, endothelial cells, requires Ca2+
Inhibitors of NOS
Scavengers of NO like Heme
L-arginine derivatives: L-NMMA, LNAME
Inhibitors of arginine binding to NOS
