Nitric oxide NO can be provided exogenously through inspiratory gas'

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(No Transcript)
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Nitric oxide (NO) can be provided exogenously
through inspiratory gas.
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When inhaled, NO travels through the trachea and
bronchioles into the alveoli.
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The NO molecules travel through the alveoli and
the epithelial cells.
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The NO molecules diffuse into vascular smooth
muscle adjacent to pulmonary arterioles where
they activate soluble guanylate cyclase (sGC).
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sGC converts guanosine triphosphate (GTP) to
cyclic guanosine monophosphate (cGMP).
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cGMP acts as a second messenger causing calcium
ions (Ca) to enter the sarcoplasmic reticulum,
where calcium ions are stored.
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The decreased concentration of calcium causes
contractile filaments of vascular smooth muscle
cells to slide apart, producing smooth muscle
relaxation and arteriolar dilation.
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INOmax (nitric oxide) for inhalation

• INOmax, in conjunction with ventilatory support
  and other appropriate agents, is indicated for
  the treatment of term and near-term (gt34 weeks)
  neonates with hypoxic respiratory failure
  associated with clinical or echocardiographic
  evidence of pulmonary hypertension, where it
  improves oxygenation and reduces the need for
  extracorporeal membrane oxygenation (ECMO).

INOmax package insert. Clinton, NJ INO
Therapeutics
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Safe and Well-Tolerated

• Important information about INOmax
• INOmax should not be used in the treatment of
  neonates known to be dependent upon right-to-left
  shunting of blood
• Methemoglobinemia is a dose-dependent side effect
  of inhaled nitric oxide therapy. Therefore,
  methemoglobin levels should be monitored during
  INOmax administration. Caution should be used
  when administering INOmax with other drugs that
  may cause methemoglobinemia regardless of their
  route of administration
• Nitrogen dioxide (NO2) forms rapidly in gas
  mixtures containing nitric oxide and oxygen. NO2
  formed in this way may cause airway inflammation
  and damage
• INOmax must be administered through a system
  which does not cause excessive generation of NO2
  and that monitors for NO, NO2 , and FiO2
• Abrupt discontinuation of INOmax therapy may lead
  to worsening of PaO2 and increasing pulmonary
  artery pressure (PAP). Deterioration in
  oxygenation and elevation in PAP may also occur
  in patients with no apparent response to INOmax

INOmax package insert. Clinton, NJ INO
Therapeutics
11
Safe and Well-Tolerated
Adverse events from the CINRGI study with an
incidence of at least 5 in patients receiving
INOmax, and that were more common in INOmax
patients compared with placebo patients. 6-month
follow-up data of patients in controlled studies
who received INOmax (n278) or placebo (n212)
found no evidence of an adverse event of
treatment on the need for rehospitalization,
special medical services, pulmonary disease, or
neurologic sequelae.

• 6-month follow-up data of patients in controlled
  studies who received INOmax (n278) or placebo
  (n212) found no evidence of an adverse event of
  treatment on the need for rehospitalization,
  special medical services, pulmonary disease, or
  neurologic sequelae.

INOmax package insert. Clinton, NJ INO
Therapeutics
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For More Information on INOmax

• Please see INOmax package insert for complete
  prescribing information
• Package insert available from www.inotherapeutics.
  com or by calling 1-877-KNOW-INO (877-566-9466)

IMK111-00557 05/2007