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Nitroglycerin được sử dụng trong các bệnh nhân người lớn cho điều trị và dự phòng cấp pectoris1 đau thắt ngực và điều trị cấp tính của CHF (ví dụ, liên quan với nhồi máu cơ tim cấp tính). Các yếu tố khác bao gồm các trường hợp khẩn cấp tăng huyết áp, tăng huyết áp động mạch phổi | 4. Vasodilators 101 References 1. Tobias JD. Nicardipine to Control Mean Arterial Pressure After Cardiothoracic Surgery in Infants and Children. Am J Ther 2001 8 3-6. 2. Milou C Debuche-Benouachkou V Semama DS et al. Intravenous Nicardipine as a First-Line Antihypertensive Drug in Neonates. Intensive Care Med 2000 26 956-958. 3. Gouyon JB Geneste B Semama DS et al. Intravenous Nicardipine in Hypertensive Preterm Infants. Arch Dis Child Fetal Neonatal Ed 1997 76 F126-127. Nitrates Nitroglycerin Indication Nitroglycerin is used in adult patients for both the acute treatment and prophylaxis of angina pectoris1 and the acute treatment of CHF e.g. associated with acute myocardial infarction . Other indications include hypertensive emergencies pulmonary hypertension and to improve coronary blood flow after cardiovascular surgery or transcatheter coronary revascularization. In pediatric patients it is used primarily for treatment of hypertensive emergencies and after cardiovascular surgery especially with cardiopulmonary bypass to improve coronary blood flow and myocardial perfusion. Mechanism of Action Nitroglycerin is a nitric oxide NO donor that causes relaxation of vascular smooth muscle and thus vasodilation by increasing the intracellular concentration of cyclic guanosine monophosphate cGMP . Increased cGMP leads to an increased intracellular calcium concentration which causes smooth muscle cells to relax. Nitroglycerin seems to dilate veins more than arteries although the coronary arteries respond well resulting in improved myocardial oxygen delivery. Systemic venous dilation results in lower atrial filling pressures preload and ventricular end diastolic pressures this effect reduces myocardial oxygen demand. Systemic arterial dilation also reduces myocardial oxygen demand by reducing afterload. Dosing Children I.V. continuous infusion initial 0.25 to 0.5 ug kg min I.V. Dose is titrated to achieve desired effect by 0.5 to 1 ug kg min increments every 3 to 5 .
