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Nitroglycerine
Published in Charles Theisler, Adjuvant Medical Care, 2023
Nitroglycerin is a prescription drug used to help treat sudden chest pain (angina) in patients with certain heart conditions (e.g., coronary heart disease). Nitroglycerin works primarily via venous dilation to lower blood pressure, but it also dilates the coronary arteries, contributing to the relief of angina.
Advanced Therapeutic Options in Acute Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Tiffany Dong, Aditi Nayak, Alanna Morris
The type of vasodilator depends on the phenotype of HF. In those with adequate cardiac output but persistently elevated left ventricular (LV) filling pressures, venodilators are a viable option. Among nitroglycerin, nesiritide, and nitroprusside, nitroglycerin offers the greatest venous dilatation compared with arterial dilation. Nitroglycerin provides a source of nitric oxide that leads to smooth vascular muscle relaxation. Doses start at 5–10 mcg/min and are titrated up to 200 mcg/min, with higher doses leading to more arterial dilation.10 Through venodilation, nitroglycerin lowers LV filling pressure and, at higher doses, decreases systemic vascular resistance and LV afterload. However, tachyphylaxis with nitroglycerin can occur hours after high doses. Alternatively, nitroprusside is another option for elevated LV filling pressures and causes equal amounts of venous and arterial dilation by providing nitric oxide. Nitroprusside can be beneficial for acute mitral regurgitation or aortic regurgitation. Patients with renal dysfunction and those on higher doses (>400 mcg/min) are at higher risk of cyanide toxicity. Because nitroprusside is a more balanced arterial and venous dilator, hypotension occurs more frequently.
Dermal filler complications and management
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
At present, the evidence to suggest the use of nitroglycerin paste is contentious at best, and therefore it should only be used if you are confident in your abilities and that you believe it is likely to be of benefit to your patients. Nitroglycerin is a prominent vasodilator, and subsequently, you should administer it with the patient lying down to decrease the risk of collapse due to cerebral or cardiac hypoperfusion. Rubbing a small volume into the affected area should cause blood vessels to dilate and hopefully increase tissue perfusion in the area of impending necrosis. It is also advisable for patients to proceed to use nitroglycerin paste two to three times daily for the next few days whilst you continue to monitor them for necrosis. Advise them that headaches or lightheadedness are common side effects of nitroglycerin treatment, and to stop using it and contact you immediately should they have any significant side effects.
Vericiguat for the treatment of heart failure with reduced ejection fraction
Published in Expert Review of Cardiovascular Therapy, 2023
Ahmed K. Siddiqi, Stephen J. Greene, Marat Fudim, Robert J Mentz, Javed Butler, Muhammad Shahzeb Khan
In a separate randomized phase-Ib, Vericiguat-Nitroglycerin Clinical Interaction (VENICE) study evaluated the co-administration of vericiguat and short-acting sublingual nitroglycerin in patients with chronic coronary syndromes, along with the safety profile and PD parameters of vericiguat [28]. 28. There was a decrease in mean SBP from (126.7 ± 17.6 mmHg on Day 0 to 115.8 ± 11.7 mmHg on Day 41) and (119.8 ± 16.6 mmHg on Day 0 to 117.6 ± 12.4 mmHg on Day 41) in the (vericiguat + nitroglycerin) and (placebo + nitroglycerin) groups, respectively, during the up-titration of vericiguat from 2.5 mg to 10 mg. A decrease in mean arterial pressure (MAP) was also seen from (90.9 ± 11.3 mmHg on Day 0 to 85.0 ± 9.3 mmHg on Day 41) and (87.5 ± 10.1 mmHg on Day 0; 87.1 ± 8.1 mmHg on Day 41) in the (vericiguat + nitroglycerin) and (placebo + nitroglycerin) groups, respectively. Moreover, mean SBP and DBP decreased 6–10 mmHg and 4–6 mmHg, while HR increased by 5–7 bpm after nitroglycerin administration. These effects observed with nitroglycerin were independent of vericiguat and occurred with all doses of vericiguat and placebo. Overall, there were statistically no significant changes observed in the SBP, DBP and HR between the (vericiguat + nitroglycerin) and (placebo + nitroglycerin) groups. Moreover, co-administration of vericiguat with nitroglycerin was overall well tolerated [28].
Pathobiology and evolving therapies of coronary artery vasospasm
Published in Baylor University Medical Center Proceedings, 2021
Monish A. Sheth, Robert J. Widmer, Hari K. Dandapantula
Nitroglycerin is an endothelium-independent vasoactive agent with the capacity to diminish myocardial oxygen demand by dilating peripheral arteries and veins, thereby causing a resultant fall in left ventricular preload and afterload. It also augments myocardial oxygen supply by dilating epicardial coronary arteries and increasing collateral and subendocardial blood flow.40 Long-acting nitrates are very useful in patients with circadian-pattern anginal attacks when taken at night. Shorter-acting nitrate therapy is useful for acute CAV. Headache and hypotension are the most common side effects limiting therapy with nitrates. Prospective double-blind studies with CCB compared with nitrates have reported similar efficacy for both agents in reducing spasm occurrence.41 Some have argued for use of both agents concurrently. CCB and nitrate therapy needs to be balanced with guideline-directed medical therapy in patients with CAD and congestive heart failure.
Anticoagulation strategy in patients with atrial fibrillation after carotid endarterectomy
Published in Acta Chirurgica Belgica, 2019
Murat Ugurlucan, Hakki Tankut Akay, Ibrahim Erdinc, Didem Melis Oztas, Cenk Conkbayir, Erdal Aslim, Cenk Eray Yildiz, Kubilay Aydin, Ufuk Alpagut
The operations were performed with deep or superficial regional anesthesia. Superficial cervical block was performed with the injection of 10 cc bupivacaine 0.05%, 6 cc lidocaine 2% and 4 cc saline combination along the lateral border of the sternocleidomastoid muscle subcutaneously. Deep cervical plexus block was performed at the level of the transverse processes of cervical vertebrae C2, C3, and C4. A combination of lidocaine hydrochloride and bupivacaine hydrochloride was injected after negative aspiration result for blood. A total amount of bupivacaine hydrochloride 2–3 mg/kg was allowed. Additional prilocaine hydrochloride was used subcutaneously at the incision line as infiltration anesthesia. Additional doses of prilocaine hydrochloride were injected intraoperatively if the patient complained of pain during the procedure. The allowed total dose of prilocaine was 5 mg/kg. Intraoperative remifentanil (0.025–0.05 mg/kg/min) maintained an adequate level of comfort, responsiveness, and cooperation. Continuous infusion of nitroglycerin was used for blood pressure control. Additional diltiazem or metoprolol was administered if needed. After de-clamping occasionally midazolam was given. Systemic heparin (100 IU/kg) was injected before clamping and was not antagonized after the procedure. A shunt was selectively used in the case of neurologic deterioration at cross-clamping test at duration of 2–3 min.