Nitric Oxide (Nitric Oxide)
Overview of Nitric Oxide
Nitric Oxide is an endogenous chemical messenger that acts as a potent vasodilator. Nitric Oxide is also involved in platelet aggregation, neurotransmission, and the immune system and exhibits antimicrobial, antitumour, and antiviral activity. Nitric oxide is synthesised from L-arginine by the action of enzyme, nitric oxide synthase and is believed to be the same substance as that of endothelium-derived relaxing factor (EDRF). Inhaled nitric oxide is highly selective pulmonary vasodilator and Nitric Oxide is under invastigation for the management of pulmonary hypertension and other bronchopulmonary disorders. Organic nitrates like glyceryl trinitrate and other nitrovasodilators such as sodium nitroprusside are now believed to exert their vasodilatory action through nitric oxide and therefore termed as nitric oxide donors.
Indication of Nitric Oxide
Nitric Oxide is primarily indicated in conditions like Asthma, Bronchopulmonary dysplasia, Cardiopulmonary bypass, Congenital heart disease, Obstructive pulmonary disease, Pulmonary hypertension, Respiratory distress syndrome, Respiratory failure.
Contraindication of Nitric Oxide
Nitric Oxide is contraindicated in conditions like Methaemoglobinaemia.
Side Effects of Nitric Oxide
The severe or irreversible adverse effects of Nitric Oxide, which give rise to further complications include Rebound Pulmonary Hypertension.,Nitric Oxide produces potentially life-threatening effects which include Methemoglobinemia, Paradoxical hypoxia. which are responsible for the discontinuation of Nitric Oxide therapy.,The signs and symptoms that are produced after the acute overdosage of Nitric Oxide include Death, Pulmonary edema, Methemoglobinemia.,The symptomatic adverse reactions produced by Nitric Oxide are more or less tolerable and if they become severe, they can be treated symptomatically, these include Headache, Hematuria, Hypotension, Increased bleeding time, Hypotension.
Precautions of Nitric Oxide
Abrupt discontinuation may lead to worsening hypotension, oxygenation, and increasing pulmonary artery pressure (PAP). Worsening oxygenation and increasing PAP may occur in patients who do not respond. Doses above 20 ppm should not be used because of the increased risk of methemoglobinemia and elevated nitrogen dioxide (NO2) levels. Methemoglobin levels and NO2 should be monitored.