Alprostadil (Prostin) clinical pharmacology:rxlist:"Alprostadil (prostaglandin E1) is one of a family of naturally occurring acidic lipids with various pharmacologic effects. Vasodilation, inhibition of platelet aggregation, and stimulation of intestinal and uterine smooth muscle are among the most notable of these effects. Intravenous doses of 1 to 10 micrograms of alprostadil per kilogram of body weight lower the blood pressure in mammals by decreasing peripheral resistance. Reflex increases in cardiac output and rate accompany the reduction in blood pressure. Smooth muscle of the ductus arteriosus is especially sensitive to alprostadil, and strips of lamb ductus markedly relax in the presence of the drug. In addition, administration of alprostadil reopened the closing ductus of new-born rats, rabbits, and lambs. These observations led to the investigation of alprostadil in infants who had congenital defects which restricted the pulmonary or systemic blood flow and who depended on a patent ductus arteriosus for adequate blood oxygenation and lower body perfusion."


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Alprostadil (Prostin) dosage information:JBC Handbook:"Manner of Administration and Dosage Guide Adult : Variable. Range 5 to 30ng/kg/minute. Neonate: Initial dose of 50 to 100ng/kg/minute. Maintenance dosage of 20 to 50ng/kg/minute, range 50 to 750ng/kg/minute. Doses greater than 100ng/kg/minute have not improved efficacy. Use of doses greater than 10ng/kg/minute may require artificial ventilation"
http://members.ozemail.com.au/~jamesbc/pages/drugs/9.htm

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Alprostadil (Prostin) how it works:medsafe:"Prostin VR is used to keep a blood vessel called the ductus arteriosis open temporarily after your child is born. Normally this blood vessel closes soon after birth. In some children who are born with heart defects, this blood vessel needs to be kept open for a longer time so that enough blood can reach the rest of the body. Once the child's heart defect has been fixed or treated, s/he will not usually need to be given Prostin VR any more, and the blood vessel should close. Your doctor may prescribe Prostin VR for other reasons. Ask your doctor if you have any questions about why Prostin VR has been prescribed for your child"
http://www.medsafe.govt.nz/Consumers/CMI/p/ProstinVR.htm

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Alprostadil (Prostin) a drug with many meanings:ismp.org:"A physician ordered "Prostin" for a patient with uterine bleeding. The physician, who previously practiced in Europe, meant to order carboprost tromethamine, which is known as PROSTIN 15 in some European and Scandinavian countries. In the US, carboprost tromethamine is called HEMABATE. However, there are two other products in the US named Prostin. PROSTIN E2 (dinoprostone, prostaglandin E2) is a 20 mg vaginal suppository used for induction of labor, cervical ripening, postpartum hemorrhage, uterine atony, and as an abortifacient. Also, PROSTIN VR Pediatric (alprostadil, prostaglandin E1) is used to maintain patency of ductus arteriosus in neonates with congenital heart defects. Hemabate is available in 250 mcg/mL, 1 mL ampuls. Prostin VR Pediatric is available in 500 mcg ampuls of 1 mL, exactly double the amount available with Hemabate, adding to the potential for confusion."
http://www.ismp.org/MSAarticles/Prostin.html

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Alprostadil (Prostin) monitoring therapy:critcare.lhsc.on.ca:"cutaneous vasodilation (sign of misplacement of infusion line) arterial pressure, HR peripheral perfusion INR/PTT CCTC Protocol: May be administered by IV infusion by an approved RN in CCTC. Must be administered via a central line. Continuous infusion requires the use of an infusion pump"
http://critcare.lhsc.on.ca/icu/cctc/procprot/pharmacy/mono2/alprostadil.html

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Alprostadil (Prostin) side effects:personalmd:"Fever, irritability, stiffness, jitteriness, flushing, diarrhea, easy bruising or bleeding may occur. If any of these effects continue or become bothersome, inform the doctor. The patient will be watched closely since seizures, a rapid or slow heart rate and breathing trouble can occur while using this medication. If you notice other effects not listed above, contact your doctor or pharmacist"
http://www.personalmd.com/drgdb/9205.htm

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Alprostadil (Prostin) nursing implications:metrohealth.org:"* Obtain baseline vital signs, monitor closely * Assess for PDA * Maintain patient's IV at all times (scalp IV is preferred) * Not compatible with anything * Be ready for intubation * NO FILTER. Primary indications: * Maintain PDA in ductal dependent congenital heart lesions. (Pulmonic atresia, pulmonic stenosis, tetralogy of Fallot, tricuspid atresia.) * Acyanotic heart disease with limited systemic blood flow. (Coarctation of the aorta; interrupted aortic arch, hypoplastic left heart syndrome) * To improve shunting after balloon septostomy has failed to improve oxygenation in certain patients with complete transposition of the great vessels"
http://www.metrohealth.org/clinical/NICU/HTML/Prostaglandin.htm

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Possible side effects of Alprostadil (Prostin) comprehensive list:drugs.com:"Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Check with your doctor immediately if the following side effects occur: Rare Curving of penis with pain during erection; erection continuing for 4 to 6 hours; erection continuing longer than 6 hours with severe and continuing pain of the penis; swelling in or pain of the testes Symptoms of too much medicine being absorbed into the body Dizziness; faintness; pelvic pain; flu-like symptoms Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome: More common Bleeding at place of injection, short-term; mild bleeding or spotting from urethra (suppository only); pain at place of injection; painful erection; stinging of urethra (suppository only) Rare Bruising or clotted blood in penis at place of injection, usually caused by an incorrect injection Female partners may experience itching or stinging of vagina when you first begin using the alprostadil suppository. These side effects may not be caused from the medicine but may result if female partner has not had frequent or recent sexual intercourse."
http://www.drugs.com/xq/cfm/pageID_0/htm_202023/type_cons/bn_Prostin%20VR/micr_medex/qx/index.htm

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How to mix a Alprostadil (Prostin):medformation:"You will need to get exact mixing instructions from your doctor or pharmacist if you are given two solutions to be mixed. Follow them carefully, asking the pharmacist or doctor any questions that you might have before injecting the medicine. After you or the pharmacist has mixed these solutions, follow the directions below, " How to draw your dose into the syringe "
http://www.medformation.com/mf/mm_usp.nsf/usp/202023.htm

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Alprostadil effective for erectile dysfunction:Doc's guide:"Argentinian clinical study results show that NexMed Inc.’s Alprox-TD(TM) topical cream to treat erectile dysfunction (ED) proved as effective in producing targeted results as compared to intracavernous injections. "The aim of our study was to evaluate the penile hemodynamic effect of a new topical formulation of alprostadil delivered to the corpus spongiosum through the glans skin," said Edgardo Becher, M.D., principal clinical investigator, professor of urology at the University of Buenos Aires and president of the Latin American Society for Impotence Research. "From the results of our study, we conclude that 500 mg of a 0.4 percent alprostadil cream incorporating the NexACT(TM) enhancer applied on the glans, produced a similar hemodynamic effect as determined by duplex ultrasonography as that seen following intracavernosal injection of alprostadil and sexual stimulation."
http://www.pslgroup.com/dg/7b9e2.htm

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