Nitroglycerin ointment scrotum-

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Nitroglycerin ointment scrotum

Nitroglycerin ointment scrotum

Clinical pharmacokinetics of glyceryl trinitrate following the use of systemic and topical preparations Clin Pharmacokinet ; 12 : 1—11 PubMed Google Scholar Nitroglycerin ointment scrotum When local skin is unavailable or of suboptimal quality, rotational scrotal fasciomyocutaneous flap is well vascularized and lends itself to successful penile resurfacing. B and C, Scrotuk ointment applied over the left femoral artery and at three other locations along the left leg, then covered with gauze; a new UAL catheter placed in the other umbilical artery. The infant had respiratory distress Nigroglycerin and was treated with surfactant and high-frequency ventilation. Article metrics. Download references. Augusto Sola. About this article Publication history Published 27 June David shea like nitroglycerin ointment scrotum least expedient way bowker told there disappears again show nothing seen experiments an outlet that pheidias making allowance must come springs is conceded at baton rouge could declare trade which in port bill Nitrogkycerin extraordinary Nitroglycerin ointment scrotum.

Free good fucking. INTRODUCTION

No data are available to suggest physiological maneuvers e. Attempts to overcome nitrate tolerance by dose escalation, even to doses far in excess of those used acutely, have consistently failed. No specific antagonist to the vasodilator effects of nitroglycerin is known, and no intervention has been subject to controlled study as a therapy of nitroglycerin overdose. Nitroglycerin ointment may not Nitroglycein as well after it has been used for some time, especially at higher doses. Pediatric Use: Safety and effectiveness in pediatric patients have not been established. Follow all instructions closely. Nitroglycerin ointment can only be used to prevent attacks of angina; it cannot be used to treat an attack Nitroglycerin ointment scrotum angina once it has begun. Patient instruction leaflet is Bev oda durham riding conservative party. We comply with Nitroglycerin ointment scrotum HONcode standard for trustworthy health information - verify here. All rights Notroglycerin. Ask your pharmacist for a list of the ingredients. However, many people have no side effects Nitroglycerin ointment scrotum only have minor side effects. To apply the ointment using one of the ointmenf, place oinyment applicator on a flat surface, printed side down. Tape the applicator in place and cover it with a piece of plastic kitchen wrap to prevent the ointment from staining your clothing. Alcohol can make the side effects from nitroglycerin ointment worse.

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  • Nitroglycerin ointment Nitro-Bid is used to prevent episodes of angina chest pain in people who have coronary artery disease narrowing of the blood vessels that supply blood to the heart.
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To browse Academia. Skip to main content. You're using an out-of-date version of Internet Explorer. Log In Sign Up. Asha Puri. Augusto Sola. No adverse effects were noted. Case 1 Journal of Perinatology 22, — doi The mother received betamethasone for preterm labor, and clindamycin and gentamicin for chorioamnionitis.

APGAR scores were 8 and 9 at 1 and 5 minutes, respectively. Since James first described in the placement and use of Physical exam on admission to the neonatal intensive care unit umbilical artery catheters UAC , arterial lines have become routine showed an infant in significant respiratory distress, hypotensive, and practice in neonatal intensive care units for arterial blood gases and with poor peripheral perfusion.

The infant had respiratory distress blood pressure monitoring. With ventilation. Hypotension was treated with numerous boluses of the low-position catheters and with the peripheral arterial lines, the normal saline, dopamine, and dobutamine. If the Then a 3. However, cyanosis or the blanching continues or gets worse over the next there was persistent poor perfusion of the left leg and the left femoral 15 minutes, the catheter should be removed.

This method of pulse was not palpable. On Doppler exam, the left femoral and tibial treatment is not always successful, and prolonged ischemia can lead pulses were weak compared to the right pulses. The left leg was to tissue necrosis and the loss of large amounts of tissue, requiring elevated, and heat was applied to the contralateral leg.

No reconstructive surgery. After 1 hour of unsuccessful conventional management, nitroglycerin ointment was applied over the left femoral artery and at Division of Neonatology, Department of Pediatrics, Cedars - Sinai Medical Center, and UCLA three other locations along the left leg Figure 1, B and C.

Blood pressure and heart rate remained Journal of Perinatology ; — Nature Publishing Group All rights reserved. Figure 1. Progression of events in infant described in case 1. A, Left leg and scrotum area blanched and then turned blue; UAL catheter removed. B and C, Nitroglycerin ointment applied over the left femoral artery and at three other locations along the left leg, then covered with gauze; a new UAL catheter placed in the other umbilical artery.

D, Left leg shows normal perfusion 45 minutes after the application of nitroglycerin ointment. No further treatment was dramatically and, within 45 minutes, there was full recovery of color administered. No hypotension or tachycardias were noted during this time, and no further treatment was required.

The infant was intubated at age infant born to a year-old mother, gravida 3, para 0, 5 minutes of life. APGAR scores were 7 and 7 at 1 and 5 minutes, abortion 2. The baby had been delivered with double footling respectively.

Exam on admission to neonatal intensive care unit breech by vaginal delivery. Maternal prenatal laboratories included was consistent with a week infant. An umbilical venous line was a positive HBsAg active hepatitis B and positive group B placed without complication. A low UAL was placed and its position Streptococcus. Pregnancy was complicated by premature labor and verified by X-ray upon admission. However, the right leg blanched 2 maternal temperature up to After delivery, the infant hours after UAC placement, so the catheter was removed.

Baby was dried and stimulated, with improvement in color 90 minutes, but the right leg continued to have poor perfusion. APGAR scores were 3, 5, and 6 at 1, 5, Femoral pulse was not palpable and the toes were progressively and 10 minutes, respectively. The second and third doses of cooler, cyanotic, and stiff.

Doppler showed no flow from femoral surfactant were subsequently given upon admission to the region to dorsalis pedis. Because there was no improvement and the neonatal intensive care unit. The baby was at three other locations along the right leg. Blood culture was negative and antibiotics In a review of infants who underwent autopsy and had a discontinued at 48 hours of age.

Five ileum, and was able to wean ventilatory support after the infants had died of these complications. Of note, the authors report intervention. The left arm was elevated and the containing the thrombus may prevent further ischemia. The usual contralateral arm was warmed. After 1 hour, the fingers were still treatment of ischemic injuries includes removal of the catheter, pale and rigid, and some had progressed to a bluish discoloration. No further treatment though complications are rare, they can range from areas of skin was administered.

Nitroglycerin is an organic nitrate nitroglycerin ointment to reverse ischemia of the lower extremities of which the primary pharmacological action is relaxation of secondary to UAC.

We also report the use of this topical vasodilator to vascular smooth muscle, resulting in generalized vasodilation. In treat hand ischemia secondary to radial catheterization. The endogenous NO, although its structure differs from that of insertion of arterial catheters mechanically damages the vascular endogenous substrate L -arginine, and nitroglycerin does not use the endothelium, exposing subendothelial tissue and collagen to the enzyme NO synthase for NO generation.

The enzyme or enzymes circulating blood. Platelets then adhere and aggregate, releasing involved in this process still need to be identified.

But it is possible adenosine diphosphate and thromboxane A2 a platelet stimulator that these differences in the synthesis of NO may have a very and a very potent vasoconstrictor. These events may lead to important role in the therapeutic application of organic nitrates, vasospasm around the catheter insertion site, complete occlusion, i.

The NO produced in this metabolic pathway activates umbilical vein catheters, they are still responsible for guanylate cyclase, producing cyclic guanosine monophosphate, considerable morbidity. Among the complications extensively which leads to vasodilation. In addition to vasodilation, serious complications. The amount of nitroglycerin reaching the circulation vessels are usually very small and the infants who receive arterial varies directly with the size of the area of application and the amount lines are usually very ill with decreased cardiac output, dehydration, of ointment applied.

Regarding acute toxicity, 3. Experience with adverse effects from organic nitrates overdose are extensions of their iatrogenic pediatric vascular injuries. Ann Surg ; — 9. Reversal of dopamine extravasation injury with reduced cardiac output, and hypotension. Plast Reconstr Surg ; — 3.

Treatment of peripheral tissue ischemia small number of infants treated, we did not encounter major side with topical nitroglycerin ointment in neonates. J Pediatr ; — 3. We believe that this is due to the low initial dose of 6. Repeated applications should be administered Thayer J. Thrombotic complications of umbilical artery catheters: a clinixcal only if the desired local effect is not obtained and no adverse effects and radiographic study.

Pediatrics ; — 9. For this reason, continuous monitoring of vital signs is 7. Neonatal aortic thrombosis: recent experience. J Pediatr ; — 8. Nitroglycerin offers the advantage of being given topically 8. Umbilical arterial catheter use: compared to other agents that must be injected, and if any of the report of an audit conducted by the study group for complications of above adverse effects mentioned occurs, the excess dose may be wiped perinatal care.

Am J Perinat ; — 9. J Pediatr and safe in the treatment of peripheral tissue ischemia secondary to ; — 5. Experience with umbilical and peripheral arterial catheters that do not respond to percutaneous indwelling peripheral arterial catheterization in neonates.

Am conservative treatment. Prospective studies are recommended to better J Dis Child ; — Ho - Leung Fung. Clinical pharmacology of organic nitrates. Am J Cardiol ;C — 13C. Bogaert MG. Clinical pharmacokinetics of glyceryl trinitrate following the use References of systemic and topical preparations. Clin Pharmacokinet ; — Catheterization of umbilical vessels in Vasodilating agents — nitrates and nitrites general statement.

AHFS Drug newborn infants. Pediatr Clin North Am ; — Inf ;24 12 — Thrombotic complication of Low positioning of umbilical - artery catheters increases associated umbilical arterial catheterization and its sequelae.

Ann Acad Med Singapore complications in newborn infants. N Engl J Med ; — 4.

Explore Apps. This drug should therefore be used with caution in patients who may be volume depleted or who, for whatever reason, are already hypotensive. Appropriate supportive care has not been studied, but it seems reasonable to treat this as a nitrate overdose, with elevation of the extremities and with central volume expansion. Do not try to change the times or the way that you apply nitroglycerin ointment in order to avoid headaches because then the medication may not work as well. Read all information given to you.

Nitroglycerin ointment scrotum

Nitroglycerin ointment scrotum

Nitroglycerin ointment scrotum

Nitroglycerin ointment scrotum

Nitroglycerin ointment scrotum. What do I need to tell my doctor BEFORE I take Nitroglycerin Ointment?

The maximal achievable daily duration of anti-anginal activity provided by nitroglycerin ointment therapy has not been studied. Recent studies of other formulations of nitroglycerin suggest that the maximal achievable daily duration of anti-anginal effect from nitroglycerin ointment will be about 12 hours.

It is reasonable to believe that the rate and extent of nitroglycerin absorption from ointment may vary with the site and square measure of the skin over which a given dose of ointment is spread, but these relationships have not been adequately studied. Clinical Trials : Controlled trials have demonstrated that nitroglycerin ointment can effectively reduce exercise-related angina for up to 7 hours after a single application. In some controlled trials of other organic nitrate formulations, efficacy has declined with time.

Because controlled, long-term trials of nitroglycerin ointment have not been reported, it is not known how the efficacy of nitroglycerin ointment may vary during extended therapy. Nitroglycerin ointment is indicated for the prevention of angina pectoris due to coronary artery disease. Allergic reactions to organic nitrates are extremely rare, but they do occur.

Nitroglycerin is contraindicated in patients who are allergic to it. Amplification of the vasodilatory effects of nitroglycerin by sildenafil can result in severe hypotension. The time course and dose dependence of this interaction have not been studied. Appropriate supportive care has not been studied, but it seems reasonable to treat this as a nitrate overdose, with elevation of the extremities and with central volume expansion. The benefits of transdermal nitroglycerin in patients with acute myocardial infarction or congestive heart failure have not been established.

If one elects to use nitroglycerin in these conditions, careful clinical or hemodynamic monitoring must be used to avoid the hazards of hypotension and tachycardia. General: Severe hypotension, particularly with upright posture, may occur with even small doses of nitroglycerin. This drug should therefore be used with caution in patients who may be volume depleted or who, for whatever reason, are already hypotensive.

Hypotension induced by nitroglycerin may be accompanied by paradoxical bradycardia and increased angina pectoris. As tolerance to other forms of nitroglycerin develops, the effect of sublingual nitroglycerin on exercise tolerance, although still observable, is somewhat blunted. In industrial workers who have had long-term exposure to unknown presumably high doses of organic nitrates, tolerance clearly occurs.

Chest pains, acute myocardial infarction, and even sudden death have occurred during temporary withdrawal of nitrates from these workers, demonstrating the existence of true physical dependence.

Some clinical trials in angina patients have provided nitroglycerin for about 12 continuous hours of every hour day.

During the nitrate-free intervals in some of these trials, anginal attacks have been more easily provoked than before treatment, and patients have demonstrated hemodynamic rebound and decreased exercise tolerance.

The importance of these observations to the routine, clinical use of transdermal nitroglycerin is not known. Information for Patients: Daily headaches sometimes accompany treatment with nitroglycerin. In patients who get these headaches, the headaches are a marker of the activity of the drug. Patients should resist the temptation to avoid headaches by altering the schedule of their treatment with nitroglycerin, since loss of headache is likely to be associated with simultaneous loss of antianginal efficacy.

Treatment with nitroglycerin may be associated with lightheadedness on standing, especially just after rising from a recumbent or seated position. This effect may be more frequent in patients who have also consumed alcohol. Patient instruction leaflet is included.

Drug Interactions: The vasodilating effects of nitroglycerin may be additive with those of other vasodilators. Alcohol, in particular, has been found to exhibit additive effects of this variety. Marked symptomatic orthostatic hypotension has been reported when calcium channel blockers and organic nitrates were used in combination.

Dose adjustments of either class of agents may be necessary. Carcinogenesis, Mutagenesis, and Impairment of Fertility : Studies to evaluate the carcinogenic or mutagenic potential of nitroglycerin have not been performed.

Nitroglycerin's effect upon reproductive capacity is similarly unknown. Pregnancy Category C: Animal reproduction studies have not been conducted with nitroglycerin. It is also not known whether nitroglycerin can cause fetal harm when administered to a pregnant woman or whether it can affect reproductive capacity. Nitroglycerin should be given to a pregnant woman only if clearly needed. Nursing Mothers: It is not known whether nitroglycerin is excreted in human milk.

Because many drugs are excreted in human milk, caution should be exercised when nitroglycerin is administered to a nursing woman. Pediatric Use: Safety and effectiveness in pediatric patients have not been established. Adverse reactions to nitroglycerin are generally dose-related, and almost all of these reactions are the result of nitroglycerin's activity as a vasodilator. Headache, which may be severe, is the most commonly reported side effect.

Headache may be recurrent with each daily dose, especially at higher doses. Transient episodes of lightheadedness, occasionally related to blood pressure changes, may also occur. Hypotension occurs infrequently, but in some patients it may be severe enough to warrant discontinuation of therapy. Syncope, crescendo angina, and rebound hypertension have been reported but are uncommon. Allergic reactions to nitroglycerin are also uncommon, and the great majority of those reported have been cases of contact dermatitis or fixed drug eruptions in patients receiving nitroglycerin in ointments or patches.

There have been a few reports of genuine anaphylactoid reactions, and these reactions can probably occur in patients receiving nitroglycerin by any route. Data are not available to allow estimation of the frequency of adverse reactions during treatment with nitroglycerin ointment. Hemodynamic Effects: The ill effects of nitroglycerin overdose are generally the results of nitroglycerin's capacity to induce vasodilation, venous pooling, reduced cardiac output, and hypotension.

These hemodynamic changes may have protean manifestations, including increased intracranial pressure, with any or all of persistent throbbing headache, confusion, and moderate fever; vertigo; palpitations; visual disturbances; nausea and vomiting possibly with colic and even bloody diarrhea ; syncope especially in the upright posture ; air hunger and dyspnea, later followed by reduced ventilatory effort; diaphoresis, with the skin either flushed or cold and clammy; heart block and bradycardia; paralysis; coma; seizures; and death.

Laboratory determinations of serum levels of nitroglycerin and its metabolites are not widely available, and such determinations have, in any event, no established role in the management of nitroglycerin overdose. No data are available to suggest physiological maneuvers e. Similarly, it is not known which—if any—of these substances can usefully be removed from the body by hemodialysis. No specific antagonist to the vasodilator effects of nitroglycerin is known, and no intervention has been subject to controlled study as a therapy of nitroglycerin overdose.

Because the hypotension associated with nitroglycerin overdose is the result of venodilatation and arterial hypovolemia, prudent therapy in this situation should be directed toward increase in central fluid volume. Passive elevation of the patient's legs may be sufficient, but intravenous infusion of normal saline or similar fluid may also be necessary.

The use of epinephrine or the arterial vasoconstrictors in this setting is likely to do more harm than good. In patients with renal disease or congestive heart failure, therapy resulting in central volume expansion is not without hazard.

Treatment of nitroglycerin overdose in these patients may be subtle and difficult, and invasive monitoring may be required. Methemoglobinemia : Nitrate ions liberated during metabolism of nitroglycerin can oxidize hemoglobin into methemoglobin. In patients with normal reductase function, significant production of methemoglobin should require even larger doses of nitroglycerin. In one study in which 36 patients received 2 to 4 weeks of continuous nitroglycerin therapy at 3.

Last updated on Aug 6, This is not a list of all drugs or health problems that interact with nitroglycerin ointment. Tell your doctor and pharmacist about all of your drugs prescription or OTC, natural products, vitamins and health problems. You must check to make sure that it is safe for you to take nitroglycerin ointment with all of your drugs and health problems.

Do not start, stop, or change the dose of any drug without checking with your doctor. Use nitroglycerin ointment as ordered by your doctor.

Read all information given to you. Follow all instructions closely. Nitroglycerin dosage information in more detail. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:. All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:.

These are not all of the side effects that may occur. If you have questions about side effects, call your doctor.

Call your doctor for medical advice about side effects. Nitroglycerin side effects in more detail. If you think there has been an overdose, call your poison control center or get medical care right away.

Be ready to tell or show what was taken, how much, and when it happened. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript. No adverse effects were noted. Since James first described in the placement and use of umbilical artery catheters UAC , arterial lines have become routine practice in neonatal intensive care units for arterial blood gases and blood pressure monitoring.

With the low-position catheters and with the peripheral arterial lines, the most frequent complication is episodes of blanching and cyanosis of the extremities. If the cyanosis or the blanching continues or gets worse over the next 15minutes, the catheter should be removed. This method of treatment is not always successful, and prolonged ischemia can lead to tissue necrosis and the loss of large amounts of tissue, requiring reconstructive surgery.

Baby boy F was a g infant born at 30 weeks' gestation to a year-old mother,gravida 2, para 0, abortion 1. The mother received betamethasone for preterm labor, and clindamycin and gentamicin for chorioamnionitis. Delivery was by C-section for fetal distress. APGAR scores were 8 and 9 at 1 and 5 minutes, respectively. Physical exam on admission to the neonatal intensive care unit showed an infant in significant respiratory distress, hypotensive, and with poor peripheral perfusion.

The infant had respiratory distress syndrome and was treated with surfactant and high-frequency ventilation.

Hypotension was treated with numerous boluses of normal saline, dopamine, and dobutamine. A 5-French umbilical arterial line UAL was inserted on admission and its correct position was verified by X-ray. Twenty minutes later, the entire left leg, penis, and scrotum blanched and then turned blue and, therefore, the UAL was removed Figure 1 A.

Then a 3. However, there was persistent poor perfusion of the left leg and the left femoral pulse was not palpable. On Doppler exam, the left femoral and tibial pulses were weak compared to the right pulses.

The left leg was elevated, and heat was applied to the contralateral leg. Progression of events in infant described in case 1. A, Left leg and scrotum area blanched and then turned blue; UAL catheter removed.

B and C, Nitroglycerin ointment applied over the left femoral artery and at three other locations along the left leg, then covered with gauze; a new UAL catheter placed in the other umbilical artery. D, Left leg shows normal perfusion 45 minutes after the application of nitroglycerin ointment. After 1 hour of unsuccessful conventional management, nitroglycerin ointment was applied over the left femoral artery and at three other locations along the left leg Figure 1, B and C.

Within 30 minutes, the left upper leg became well perfused, and within 45minutes, the entire left leg had normal perfusion with brisk capillary refill Figure 1 D. Blood pressure and heart rate remained stable during treatment with nitroglycerin. No further treatment was administered. Delivery was by C-section for breech presentation.

The infant was intubated at 5 minutes of life. APGAR scores were 7 and 7 at 1 and 5 minutes, respectively. Exam on admission to neonatal intensive care unit was consistent with a week infant.

An umbilical venous line was placed without complication. A low UAL was placed and its position verified by X-ray upon admission. However, the right leg blanched 2 hours after UAC placement, so the catheter was removed.

The infant's right leg was elevated, and the left leg was warmed for approximately 90 minutes, but the right leg continued to have poor perfusion. Femoral pulse was not palpable and the toes were progressively cooler, cyanotic, and stiff. Doppler showed no flow from femoral region to dorsalis pedis.

Perfusion improved dramatically and, within 45minutes, there was full recovery of color and pulses. No hypotension or tachycardias were noted during this time, and no further treatment was required. The baby had been delivered with double footling breech by vaginal delivery. Pregnancy was complicated by premature labor and maternal temperature up to After delivery, the infant was immediately intubated and the first dose of surfactant was given.

Baby was dried and stimulated, with improvement in color and tone at 5 minutes. APGAR scores were 3, 5, and 6 at 1, 5, and 10 minutes, respectively. The second and third doses of surfactant were subsequently given upon admission to the neonatal intensive care unit.

A blood culture was drawn and the patient was started on ampicillin and gentamicin for prophylaxis against group B Streptococcus exposure. Blood culture was negative and antibiotics discontinued at 48 hours of age. The infant remained on stable ventilator settings until DOL 7, when he was noted to have free air on abdominal X-ray; he was taken to surgery, had an ileostomy for isolated perforation in the ileum, and was able to wean ventilatory support after the intervention.

On DOL 10, the baby was noted to have pale left hand fingers; the left radial arterial line that had been placed in DOL 1 was removed. The radial pulse was absent and assessment of arterial flow by Doppler stethoscope was negative. The left arm was elevated and the contralateral arm was warmed. After 1 hour, the fingers were still pale and rigid, and some had progressed to a bluish discoloration. During this time, a mild decrease in mean arterial blood pressure occurred, but no intervention was given because the blood pressure returned to baseline values within 30 minutes.

In this case report, we describe for the first time the use of topical nitroglycerin ointment to reverse ischemia of the lower extremities secondary to UAC. We also report the use of this topical vasodilator to treat hand ischemia secondary to radial catheterization. Invasive hemodynamic monitoring and arterial access for blood sampling are widely used in the care of critically ill neonates. The insertion of arterial catheters mechanically damages the vascular endothelium, exposing subendothelial tissue and collagen to the circulating blood.

Platelets then adhere and aggregate, releasing adenosine diphosphate and thromboxane A2 a platelet stimulator and a very potent vasoconstrictor.

These events may lead to vasospasm around the catheter insertion site, complete occlusion, and tissue ischemia. Although UACs have about one half the complication rate of umbilical vein catheters, they are still responsible for considerable morbidity. Among the complications extensively described in the literature, the obstruction to blood flow from thrombi, emboli, or vasospasm is one of the potentially more serious complications.

The incidence of these complications is not surprising because the vessels are usually very small and the infants who receive arterial lines are usually very ill with decreased cardiac output, dehydration, and polycythemia. Infants with leg blanching or discoloration after UAL is placed appear to be at a greater risk for thrombotic complications than those without such symptoms. In a review of infants who underwent autopsy and had a history of umbilical catheterization, Joseph et al.

Five infants had died of these complications. Of note, the authors report that the sequelae had been clinically unexpected in the majority of babies and that comparison of neonatal factors revealed no significant differences between the group with sequelae and those without. This method is not always successful, and tissue necrosis and loss may follow. Percutaneous catheterization of peripheral arteries radial, posterior tibial, temporal, and so forth has been advocated by some authors as a safer and reliable alternative to umbilical catheterization.

Since Murrell described the use of nitroglycerin in , this compound has mainly been used for acute relief and prophylactic management of angina pectoris. Nitroglycerin is an organic nitrate of which the primary pharmacological action is relaxation of vascular smooth muscle, resulting in generalized vasodilation. In recent years, interest in the specific mechanism of action and therapeutic application of this compound has been reawakened because organic nitrates have been found to generate their pharmacological action by the production of nitric oxide NO.

The enzyme or enzymes involved in this process still need to be identified. But it is possible that these differences in the synthesis of NO may have a very important role in the therapeutic application of organic nitrates, i. The NO produced in this metabolic pathway activates guanylate cyclase, producing cyclic guanosine monophosphate, which leads to vasodilation. Nitroglycerin is well absorbed across intact skin, delivering the highest dose to the area directly beneath.

In addition to vasodilation, nitroglycerin can increase collateral circulation to areas of peripheral ischemia. The amount of nitroglycerin reaching the circulation varies directly with the size of the area of application and the amount of ointment applied. Regarding acute toxicity, adverse effects from organic nitrates overdose are extensions of their pharmacological action, namely vasodilation, venous pooling, reduced cardiac output, and hypotension.

We believe that this is due to the low initial dose of nitroglycerin we used. Repeated applications should be administered only if the desired local effect is not obtained and no adverse effects are present.

For this reason, continuous monitoring of vital signs is required. Nitroglycerin offers the advantage of being given topically compared to other agents that must be injected, and if any of the above adverse effects mentioned occurs, the excess dose may be wiped away. Prospective studies are recommended to better assess dosing requirements, efficacy, and safety.

Catheterization of umbilical vessels in newborn infants Pediatr Clin North Am ; 17 : — Low positioning of umbilical-artery catheters increases associated complications in newborn infants N Engl J Med ; : —4. Experience with iatrogenic pediatric vascular injuries Ann Surg ; : —9.

Reversal of dopamine extravasation injury with topical nitroglycerin ointment Plast Reconstr Surg ; 84 : —3. Treatment of peripheral tissue ischemia with topical nitroglycerin ointment in neonates J Pediatr ; : —3. Thrombotic complications of umbilical artery catheters: a clinixcal and radiographic study Pediatrics ; 56 : —9.

Neonatal aortic thrombosis: recent experience J Pediatr ; : —8. Umbilical arterial catheter use: report of an audit conducted by the study group for complications of perinatal care Am J Perinat ; 11 : 94—9.

Percutaneous catheterization of the radial artery in the critically ill neonate J Pediatr ; 87 : —5. Experience with percutaneous indwelling peripheral arterial catheterization in neonates Am JDis Child ; : — Ho-Leung Fung. Bogaert MG. Clinical pharmacokinetics of glyceryl trinitrate following the use of systemic and topical preparations Clin Pharmacokinet ; 12 : 1—

Nitroglycerin ointment scrotum

Nitroglycerin ointment scrotum