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ICU Primary Snippet – iNO & Prostacyclins
Arkistoidut sarjat ("Toimeton syöte" status)
When? This feed was archived on March 22, 2023 22:09 (). Last successful fetch was on February 16, 2023 22:14 ()
Why? Toimeton syöte status. Palvelimemme eivät voineet hakea voimassa olevaa podcast-syötettä tietyltä ajanjaksolta.
What now? You might be able to find a more up-to-date version using the search function. This series will no longer be checked for updates. If you believe this to be in error, please check if the publisher's feed link below is valid and contact support to request the feed be restored or if you have any other concerns about this.
Manage episode 354438252 series 2593352
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ICU Primary Snippet – iNO & Prostacyclins
Dr Swapnil Pawar
Notes by Dr Madhuri Anupindi
Nitric oxide:
Mechanism of action:
- Rapidly absorbed into pulmonary circulation Activates guanylate cyclase (soluble enzyme in cytosol version – natural version is membrane found protein) converts GTP into cGMP activates protein kinase G inhibits IP3-mediated release of calcium, phosphorylates voltage gated ca channels (inactivates), phosphorylates phospholamban (regulates ca pump) which increases ca uptake in sarcoplasmic reticulum smooth muscle relaxation pulmonary vasodilation in ventilated regions hopefully increases VQ matching
Potential adverse effects
- Methemoglobinemia
- Nitric oxide reacts with oxyhaemoglobin to form metHb and nitrate and with deoxyhaemoglobin to form nitrosyl haemoglobin this is converted to methaemoglobin on exposure to oxygen.
- Nitric oxide can also combine with oxygen and water to produce nitrogen dioxide, and nitrite, which can interact with oxyhaemoglobin to produce methaemoglobin and nitrate formation of nitrogen dioxide depends on the nitric oxide concentration, fio2 and the amount of time they are exposed to each other
- Adverse effects from nitrogen dioxide: worsens ARDS, bronchiolitis, pneumonitis, airway injury
- Renal failure (RR 1.6)
- Rebound pulmonary hypertension and hypoxia with abrupt withdrawal
- Platelet inhibition
- Increased blood flow to the left heart may cause APO if LV dysfunction.
Inhaled prostacyclin:
Mechanism of action:
- Derivative of arachidonic acid
- activates G protein-coupled receptors on platelets, and vascular endothelial cells,
- activates adenylate cyclase,
- increases intracellular cAMP
- inhibits further platelet activation + activates protein kinase A
- phosphorylates and inhibits myosin light chain kinase
- smooth muscle relaxation and vasodilatation
- cAMP inhibits platelet aggregation (prevents increased intracellular calcium)
Potential adverse effects
- System vasodilatation
- Flushing
- Headache
- Hypotension + tachycardia
- Bronchospasm
- May increase the risk of bleeding (inhibits platelet function)
- Glycine (sterile diluent) can block expiratory filter
- increases resistance
- Decreased gastric emptying
- Inhibition of gastric acid secretion
26 jaksoa
Arkistoidut sarjat ("Toimeton syöte" status)
When? This feed was archived on March 22, 2023 22:09 (). Last successful fetch was on February 16, 2023 22:14 ()
Why? Toimeton syöte status. Palvelimemme eivät voineet hakea voimassa olevaa podcast-syötettä tietyltä ajanjaksolta.
What now? You might be able to find a more up-to-date version using the search function. This series will no longer be checked for updates. If you believe this to be in error, please check if the publisher's feed link below is valid and contact support to request the feed be restored or if you have any other concerns about this.
Manage episode 354438252 series 2593352
- play_arrow
ICU Primary Snippet – iNO & Prostacyclins
Dr Swapnil Pawar
Notes by Dr Madhuri Anupindi
Nitric oxide:
Mechanism of action:
- Rapidly absorbed into pulmonary circulation Activates guanylate cyclase (soluble enzyme in cytosol version – natural version is membrane found protein) converts GTP into cGMP activates protein kinase G inhibits IP3-mediated release of calcium, phosphorylates voltage gated ca channels (inactivates), phosphorylates phospholamban (regulates ca pump) which increases ca uptake in sarcoplasmic reticulum smooth muscle relaxation pulmonary vasodilation in ventilated regions hopefully increases VQ matching
Potential adverse effects
- Methemoglobinemia
- Nitric oxide reacts with oxyhaemoglobin to form metHb and nitrate and with deoxyhaemoglobin to form nitrosyl haemoglobin this is converted to methaemoglobin on exposure to oxygen.
- Nitric oxide can also combine with oxygen and water to produce nitrogen dioxide, and nitrite, which can interact with oxyhaemoglobin to produce methaemoglobin and nitrate formation of nitrogen dioxide depends on the nitric oxide concentration, fio2 and the amount of time they are exposed to each other
- Adverse effects from nitrogen dioxide: worsens ARDS, bronchiolitis, pneumonitis, airway injury
- Renal failure (RR 1.6)
- Rebound pulmonary hypertension and hypoxia with abrupt withdrawal
- Platelet inhibition
- Increased blood flow to the left heart may cause APO if LV dysfunction.
Inhaled prostacyclin:
Mechanism of action:
- Derivative of arachidonic acid
- activates G protein-coupled receptors on platelets, and vascular endothelial cells,
- activates adenylate cyclase,
- increases intracellular cAMP
- inhibits further platelet activation + activates protein kinase A
- phosphorylates and inhibits myosin light chain kinase
- smooth muscle relaxation and vasodilatation
- cAMP inhibits platelet aggregation (prevents increased intracellular calcium)
Potential adverse effects
- System vasodilatation
- Flushing
- Headache
- Hypotension + tachycardia
- Bronchospasm
- May increase the risk of bleeding (inhibits platelet function)
- Glycine (sterile diluent) can block expiratory filter
- increases resistance
- Decreased gastric emptying
- Inhibition of gastric acid secretion
26 jaksoa
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