NITROGLYCERIN (Nitroglycerinum).

     In chemically nitroglycerin is trinitratom glycerin.

     C inonimy : Angibid, Anginine [a synonym parmidina (see), Angiolingual, Angised, Angorin, Glyceryl trinitrate, Myoglycerin, Nitrangin, Nitrocardiol, Nitroglycerol, Nitroglyn, Nitromint, Nitrostat, Nitrozell, Trinitrin, Trinitroglycerol, Trinitrol and others.

     Colorless liquid masloobraznaya. Poor soluble in water, a well-to alcohol, ether, chloroform.

     For use in medical practice nitroglycerine the form of finished dosage forms : a) 1% nitroglycerin solution (Solutio Nitrogl lenses rini 1% or Nitrogli semester rinum solutum); 1% nitroglycerin solution in alcohol; Clear colourless liquid; B) nitroglycerin tablets (T abulett Nitroglycerini s) containing on 0.0005 g (0.5 mg) nitroglycerin, which represents about three drops of 1% solution; c) 1% nitroglycerin solution in the oil capsules (Solutio Nitroglycerini 1% of leosa in capsulis) containing 0.5 mg or 1 mg nitroglycerin.

     These drugs are being used primarily for acute edema strokes. To prevent attacks mainly appointed acting drugs (see below).

     For intravenous drug produced a special form of nitroglycerin.

     Nitroglycerine is readily absorbed skin and skin irritation, but not from the gastrointestinal tract, so it much better if sublingual application.

     With sublingual admission (in the form of the solution, tablets or capsules), nitroglycerine quickly into the blood. The effect is 1 to 2 minutes, and lasts 20 to 30 minutes. In testimony to the mucous membranes of polymer films, nitroglycerin absorbed slowly, but over prolonged periods. Yet slowly absorbed and enduring a smoke when administered in the form of dosage forms (see Nitrogranulong, Sustak etc.). When intravenously effect develops rapidly.

     Depending on the form and method of drug use, nitroglycerine and finished dosage forms are designated for edema or prevent strokes.

     Nitroglycerin also applied to levozheludochkovoy failure, including heart attacks, sometimes in the central artery embolism retina.

     Along with lower resistance coronary and peripheral vascular, nitroglycerin reduces venous return blood to the heart, to redistribute blood flow in the heart of the home and a reduction in ischemic heart attack pockets of coronary defeat reinforces inotropnuyu function attack. Like other organic nitrates, nitroglycerin improves metabolic processes in the attack, reduces the need for oxygen in the attack.

     Currently 1% (alcohol) solution sublingual nitroglycerin use rarely used. Most use pills or capsules. In applying the 1% solution to cause 1 - 2 drops of language or moistened with 2 to 3 drops of a small piece of sugar and keep his mouth (with language), not proglatyvaya to complete intake.

     Pills (1 / 2 - 1 pill) is placed under ground and proglatyvayut (keep in his mouth until the full intake).

     Higher doses of 1% solution of nitroglycerin for adults : single drop of 4, daily 16 drops (of 1, 5 and 6 single pill tablets daily).

     Capsule is being detained until resorption language, but to accelerate the effect can be crushed capsule teeth.

     The frequency and duration of use of drops, tablets and capsules zavisnt of frequency, intensity strokes, efficiency and portability. Usually after cupping the process of intake of prolonged action. In nerezko expressed cramps sometimes designate nitroglycerin (1 - 2% alcohol solution) into the mixture with menthol or validolom, Zvanets settings, herb (see "Drops Votchala").

     In practice, and an ambulance (with heart attacks, severe heart failure) designate intravenous nitroglycerin. Before intravenous provide for 1 - 2 pills sublingvalno every 5 to 10 minutes.

     When using nitroglycerin (and nitrates) in various pharmaceutical forms should be aware that their continuous long reception led to the development of tolerance, which for the previous antianginalnogo and hemodynamic effect, requires a larger dose, and sometimes frequency receptions.

     The development of tolerance to organic nitrates is connected, apparently, with a gradual reduction of tsGMF and lower education NO (see earlier).

     Because patients usually have very long-term use of nitrates, must constantly monitor the effectiveness of therapy, carefully regulated dose, if necessary, increasing temporarily (for a few days) cancel the admission of these products and replace them with other drugs antianginalnymi groups.

     When using drugs nitroglycerin often transient headache, dizziness possible, the reduction of AD (especially in vertical position) and in overdose - Orthostatic collapse.

     Contraindications : bleeding in the brain, increased intracranial pressure, expressed hypotension, and zakrytougolnaya of glaucoma, high inner pressure. In open - glaucoma nitroglycerin no contraindications.

     Method of issuance : 1% solution of alcohol in nitroglycerin sklyankah to 5 ml; Tablets containing 0.0005 g (0.5 mg) of nitroglycerin in glass tubes for 40 pieces; 1% solution in oil in capsules (spherical, red color) for 0.5 and 1 mg in a package of 20 pieces, as well as the injection dosage forms of drugs and prolonged action (see below).

     Storage : List B; 1% solution in a well-ukuporennyh sklyankah in a cool, the dark place, away from the fire; Pill-in the dark places; Encapsulated in a dry, cool, the dark place, away from the fire.

     With nitroglycerin should proceed with caution because the explosion can occur if a significant number will be shed and alcohol evaporation.

     It should guard against falling solutions nitroglycerin on the skin, because it can be absorbed and cause a headache.

     Rp. : Sol. Nitroglycerini 1% 5 ml

     D.S. At 2 to 3 drops of language (for a piece of sugar)

     Rp. : Tab. Nitroglycerini 0.0005 N.40

     D.S. At one pill (of the language)

     Rp. : Sol. Nitroglycerini oleosae 1% in caps. 0.0005 N.20

     D. S. At one capsule under the language (capsule down on the teeth)

     Rp. : T-rae Convallariae

     T-rae Valerianae aa 10 ml

     Sol. Nitroglycerini 1% 1 ml

     Validoli 2 ml

     M.D.S. For 10 - 15 drops of 3 to 4 times a day

     M and P r h e and h is a mixture of pay as finished products under the name of "Drops Votchala '''.

     In acute levozheludochknovoy deficiencies, including heart attacks, as well as blindness to other forms of treatment stenokardii6 resort with intravenous nitroglycerin solution. For this purpose, issued a special drug ampulnaya a 1% solution ( "concentrate"), which directly to the planting of isotonic sodium chloride solution to a 0.01% solution (0.1 mg = 100 µ g in 1 ml).

     Enter 0.01% solution drip. The initial speed of 25 µ g / min (1 ml of 0.01% solution for 4 min). The speed of regulated individually, reaching reductions in AD 10-25% of baseline (systolic pressure should not be below 90 mm Hg. Art.) . With insufficient effect of increasing the speed limit to 25 minutes in every 15 - 20 minutes. Typically, the number of nitroglycerin required to obtain greater than 100 µ g (1 ml of 0.01% solution) per minute. In some cases, the doses can be higher (up to 2 - 4 ml / min).

     Further increases in inappropriate doses. Duration is a clinical indications and can take 2 - 3 day. If necessary, introduce a solution nitroglycerin again.

     In connection with peripheral vazodilatatornymi properties nitroglycerin it has been managed for arterial hypotension with surgical intervention.

     In all cases, intravenous nitroglycerin should be carefully monitored (AD measurement, recording EKG, etc.). Doses should be selected individually; Excess optimal doses can cause kollaptoidnoe state violations of heart rhythm.

     Abroad produced many dosage forms nitroglycerin injection.

     Perlinganit-solution (Re rlinganit)

     Available in capsules of 10 ml 0.1% nitroglycerin solution in isotonic solution of glucose (10 mg vials of nitroglycerin in 1 = 1 mg in 1 mL), as well as in bottles of 50 ml of the same solution.

     Applied as divorced "Concentrate" nitroglycerin (see earlier).

     The so-called "Perlinganit" also produces capsules nitroglycerin (sublingual application strokes by razzhevyvaniya).

     Nitra 5 mg / ml concentration was nitroglycerin for infusions (1 ml containing 5 mg nitroglycerin, 345 mg of ethyl alcohol, propylene Z00 mg, water for injection to 1 ml). Before use to throw in isotonic sodium chloride solution, or 5% glucose solution to a 0.01% solution of nitroglycerin.

     Nitro Poppy (Nitr Mas o-k) *. Capacity of 5 ml ampoules contain 5 mg nitroglycerin in the alcohol solution.

     Nitro benefit (Nitr o-Ro l) *. Ampoules of 5 and 25 ml and 50 ml bottles of 0.1% solution of nitroglycerin.

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