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Related Concept Videos

Treatment for Pulmonary Arterial Hypertension: Phosphodiesterase Inhibitors01:28

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Phosphodiesterase 5 (PDE5) inhibitors are potent enzymes that function to hydrolyze cyclic nucleotides to their corresponding 5' monophosphates. Their unique biochemical properties have been applied in treating Pulmonary Arterial Hypertension (PAH).
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Nitric Oxide Signaling Pathway01:28

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Nitric oxide (NO), an inorganic gas, acts as a potent second messenger in most animal and plant tissues. NO diffuses out of the cells that produce it and enters the neighboring cells to generate a downstream response. NO synthase (NOS) catalyzes NO production by the deamination of the amino acid arginine. There are three isoforms of NOS. Endothelial cells have endothelial NOS (eNOS), nerve and muscle cells have neuronal NOS (nNOS), and macrophages produce inducible NOS (iNOS) upon exposure...
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Treatment for Pulmonary Arterial Hypertension: Oxygen Therapy for Respiratory Failure01:16

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Oxygen therapy has emerged as a significant tool in enhancing the quality of life for patients suffering from pulmonary arterial hypertension (PAH). While this therapy has principally been studied on patients with significant hypoxemia, this therapeutic approach helps prevent potential organ damage and can be administered in the comfort of one's home.
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Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists01:23

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Prostacyclin receptor agonists are a class of therapeutic agents integral to managing pulmonary arterial hypertension (PAH). These drugs operate by mimicking the action of prostaglandin I2, or PGI2, a naturally occurring compound in the body.
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Drug Delivery: Enteral Route01:18

Drug Delivery: Enteral Route

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The enteral drug administration involves three primary routes: oral, sublingual, and buccal. Oral ingestion is the most prevalent, safe, economical, and convenient method for drug administration. However, it has certain drawbacks, including limited absorption due to the drug's low water solubility or poor membrane permeability, possible emesis from GI mucosa irritation, destruction of drugs by digestive enzymes or low gastric pH, and irregular absorption along with food or other drugs.
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Antihypertensive Drugs: Vasodilators01:23

Antihypertensive Drugs: Vasodilators

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Vasodilators, primarily affecting the smooth muscles within arterial and venous walls, are commonly used for hypertension treatment. Medications such as minoxidil and hydralazine primarily target arteries and arterioles, while sodium nitroprusside acts on arterioles and venules. Minoxidil, functioning as a prodrug, is metabolized by hepatic sulfotransferase into its active form, minoxidil sulfate, after oral administration. This metabolite binds to the sulfonylurea receptor (SUR) component of...
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Related Experiment Video

Updated: Jun 10, 2025

A Novel Inhalation Mask System to Deliver High Concentrations of Nitric Oxide Gas in Spontaneously Breathing Subjects
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Sildenafil as Bridge Therapy for Inhaled Nitric Oxide in Preterm Neonates.

Harris Khawaja1, Timothy A Sanders1, Michael Schreiber1

  • 1Department of Pediatrics (HK, TAS, MS, GB), University of Chicago Medicine Comer Children's Hospital, Chicago, IL.

The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG
|October 16, 2024
PubMed
Summary

Sildenafil helped most preterm infants discontinue inhaled nitric oxide (iNO) treatment, preventing rebound pulmonary hypertension without adverse effects. This study explored sildenafil

Keywords:
inhaled nitric oxideneonatepersistent pulmonary hypertensionphosphodiesterase type 5premature neonateprematuritysildenafil

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Area of Science:

  • Neonatal Medicine
  • Pediatric Cardiology
  • Pharmacology

Background:

  • Inhaled nitric oxide (iNO) is crucial for treating persistent pulmonary hypertension in neonates.
  • Abrupt cessation of iNO can lead to dangerous rebound pulmonary hypertension.
  • Alternative strategies are needed to safely wean infants from iNO.

Purpose of the Study:

  • To evaluate the efficacy of sildenafil in facilitating the weaning process from iNO in preterm neonates.
  • To assess the safety profile of sildenafil when used for iNO discontinuation in this population.

Main Methods:

  • Retrospective chart review of preterm neonates (gestational age < 34 weeks) receiving iNO and sildenafil between 2017-2021.
  • Inclusion criteria: receiving iNO, started on sildenafil for iNO weaning, no major congenital anomalies.
  • Exclusion criteria: congenital heart disease, congenital diaphragmatic hernia.

Main Results:

  • Seven neonates (GA 22 5/7 to 31 0/7 weeks) with prior failed iNO weaning attempts were identified.
  • Sildenafil doses: 0.125 mg/kg IV q8h or 0.25 mg/kg enteral q8h.
  • iNO discontinuation within 48 hours (4 infants), 5 days (1 infant), or 10 days (1 infant) of sildenafil initiation.
  • One infant experienced weaning failure; no adverse events like hypotension or death were reported.

Conclusions:

  • Sildenafil effectively facilitated iNO weaning in the majority of evaluated preterm neonates.
  • The use of sildenafil for iNO weaning in this cohort was associated with a favorable safety profile.
  • Sildenafil presents a viable option to manage iNO discontinuation in vulnerable preterm infants.