Inhaled nitric oxide is used:
Correct Answer: For reducing pulmonary hypertension
Description: Ans. is 'd' i.e. for reducing pulmonary hypertension According to Goodman Gilman "Inhaled nitric oxide has been approved by FDA for use in newborns with persistent pulmonary hypertension and has become the first line therapy for this disease. In this disease state NO inhalation has been shown to reduce, significantly, the necessity for extracorporeal oxygenation"Nelson reports the effect of NO in pulmonary arterial hypertension "iNO is a selective and potent pulmonary vasodilator (equivalent to endothelium derived relaxation factor). When it is given at an initial dose of 1-20 ppm it improves oxygenation in patients with persistent primary pulmonary hypertension and it reduces the need for extracorporeal membrane oxygenation ".Response to iNO includes:No improvementinitial improvement but not sustained, so extracorporeal membrane oxygenation is required.initial and sustained improvement, usually weaned by 5th day of therapy.initial response but prolonged dependency, possibly as a result of pulmonary hypoplasia or alveolar capillary dysplasia.Inhale Nitric oxide only affects the pulmonary vasculature i.e. it does not affect the systemic circulation.It does not affect the systemic circulation because on exposure to pulmonary circulation it strongly binds with the oxyhemoglobin and gets inactivated by the oxyhemoglobin.Inhaled nitric oxide improves ventilation perfusion ratio because inhaled nitric oxide is distributed only to the ventilated areas of the lung and dilates only those vessels which are directly adjacent to the ventilated alveoli.Thus inhaled NO will decrease pulmonary artery pressure and pulmonary vascular resistance and often improves oxygenation.More on inhaled nitric oxide :Due to its selective pulmonary vasodilating action, inhaled Nitric Oxide is undergoing intensive study as a potential therapeutic agent for numerous diseases associated with increased pulmonary vascular resistance.Several small studies and case reports have suggested potential benefits of inhaled NO in a variety of conditions includingweeing from cardiopulmonary bypass in adultscongenital heart diseaseprimary pulmonary hypertensionpulmonary embolismacute chest syndrome in sickle cell patientscongenital diaphragmatic herniahigh altitude pulmonary edemalung transplantationBut larger prospective randomized studies have not yet been performed or have failed to confirm any changes in the outcome. At the present time outside of clinical investigation, therapeutic use and benefit of inhaled NO are limited to newborns with persistent pulmonary hypertension.
Category:
Pharmacology
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