Sodium nitroprusside General

Sodium nitroprusside is a mixed arterial-venous vasodilator that acts directly on vascular smooth muscle to increase cardiac index and decrease venous pressure. Despite its lack of direct inotropic activity, nitroprusside exerts hemodynamic effects that are qualitatively similar to those of dobutamine and milrinone. However, nitroprusside generally decreases PAOP, SVR, and blood pressure more than those agents do. 

This chapter describes four vasodilators in detail. Two of these agents, hydralazine and minoxidil, are effective orally and are used for the chronic treatment of primary hypertension. The other two drugs, diazoxide and sodium nitroprusside, are effective only when administered intravenously. They are generally used in the treatment of hypertensive emergencies or during surgery. 

Detection.—Sulphur in the free state is readily recognisable by its general appearance and characteristics, and especially by its combustion to sulphur dioxide. Both in mixtures and compounds the presence of the element can be demonstrated by heating with charcoal and an alkali carbonate,2 or even better, on a small scale, by heating with an equal bulk of sodium or potassium,3 or with powdered iron 4 in each case some of the sulphur is converted into sulphide, which may be detected by the action of an aqueous extract on mercury or silver, or on sodium nitroprusside the metals are blackened, whilst the nitro-prusside is very sensitive in giving a purple coloration (see p. 62). Alternatively, the solution of the alkali sulphide may be acidified and tests applied for hydrogen sulphide to the vapours evolved on warming. 

Chapter 12 contains a general discussion of vasodilators. All of the vasodilators useful in hypertension relax smooth muscle of arterioles, thereby decreasing systemic vascular resistance. Sodium nitroprusside also relaxes veins. Decreased arterial resistance and decreased mean arterial blood pressure elicit compensatory responses, mediated by baroreceptors and the sympathetic nervous system (Figure 11-5), as well as renin, angiotensin, and aldosterone. Because sympathetic reflexes are intact, vasodilator therapy does not cause orthostatic hypotension or sexual dysfunction. 

When potassium ferricyanide is warmed with a solution of bleaching powder to 70° C. a considerable evolution of gas takes place, and a reddish deposit of ferric oxide and calcium carbonate is formed. The filtered solution is concentrated and the potassium nitroprusside extracted with alcohol, and converted into the insoluble copper salt by addition of cupric chloride. This latter is decomposed with sodium hydroxide, yielding the sodium salt, which may be further purified by dissolving in a little water, addition of alcohol, and subsequent evaporation after filtering off any insoluble material.2 The constitution to be assigned to sodium nitroprusside in particular, and hence to nitro-prussides in general, has been a subject of debate, Browning s3 formula is —... 

The single-line absorber is generally potassium (or sodium) nitroprusside, K4Fe(CN)g,3H20, enriched with Fe. 

This reaction is based on the formation of a color in a mixture of an aqueous sodium nitroprusside solution with carbonyl compounds in an alkaline medium. A positive test is obtained with aliphatic and certain aromatic aldehydes and aromatic and aliphatic ketones. The literature data on this reaction are conflicting and no general rule can be expressed about which carbonyl compounds give the reaction and which do not. For example, the color is not produced with formaldehyde, glyoxal, benzaldehyde, o-hydroxy-benzaldehyde, chloral, vanillin, benzophenone, naphthyl phenyl ketone, trihydroxybenzophenone, benzil, acetophenones substituted on the aromatic nucleus with hydroxyl, etc. The reaction can therefore be used for the differentiation of certain types of aldehydes and ketones, as, for example, acetaldehyde from formaldehyde, and acetophenone from benzophenone or hydroxyacetophenone, etc. Further, various colors formed in alkaline media or after the subsequent acidification of the reaction mixture can also be used for differentiation. Sodium hydroxide can be replaced by ammonia, piperidine... 

Note cautiously the characteristic odour of acetaldehyde which this solution possesses. Then with the solution carry out the following general tests for aldehydes described on p. 341 Test No. I (SchiflF s reagent). No. 3 (Action of sodium hydroxide). No. 4 (Reduction of ammoniacal silver nitrate). Finally perform the two special tests for acetaldehyde given on p. 344 (Nitroprusside test and the Iodoform reaction). 

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