Mechanism
How Nitric Oxide works
Diffuses into pulmonary vascular smooth muscle and activates guanylate cyclase, increasing cGMP and causing selective pulmonary vasodilation.
← Respiratory Pharmacology
PVDNBRC High Yield5/5 Importance
Nitric Oxide Respiratory Pharmacology Guide
The complete learning guide for class, mechanism, indications, adverse effects, kinetics, exam traps, and NBRC-style respiratory pharmacology.
Nitric oxide is an inhaled pulmonary vasodilator used most classically for persistent pulmonary hypertension of the newborn and selected cases of refractory hypoxemia with pulmonary hypertension physiology. It improves ventilation-perfusion matching by selectively dilating pulmonary vessels in ventilated lung units. Key monitoring concerns include methemoglobinemia, nitrogen dioxide toxicity, and rebound pulmonary hypertension if discontinued abruptly.
Clinical Pharmacology
Understand the medication before memorizing it
Start with mechanism, clinical pearls, onset, peak, duration, and deeper pharmacology explanations so the rest of the page has context.
Clinical Pearl
What to remember
Never stop iNO abruptly; rebound pulmonary hypertension is a classic board-style safety issue.
Kinetics
Onset, peak, and duration
1
Onset
Minutes
2
Peak
Rapid
3
Duration
Only while continuously delivered
Clinical Practice
How this medication is used at the bedside
Review common indications, expected adverse effects, contraindications, cautions, and safety issues in a clinically useful order.
Quick facts
- Subclass
- Inhaled pulmonary vasodilator
- NBRC importance
- 5/5
- Difficulty
- 4/5
- Brands
- iNO, INOmax
5/5
NBRC importance
13
Study facts
0
Practice questions
2026
Updated
Common indications
- Persistent pulmonary hypertension of the newborn
- Severe hypoxemic respiratory failure with pulmonary hypertension physiology
- Rescue therapy for refractory hypoxemia in selected ICU patients
Adverse effects
- Methemoglobinemia
- Nitrogen dioxide toxicity
- Rebound pulmonary hypertension
- Hypotension
- Worsening oxygenation if withdrawn abruptly
Contraindications
- Hypersensitivity to formulation components
Cautions and safety issues
- Monitor methemoglobin levels
- Monitor nitrogen dioxide levels
- Avoid abrupt discontinuation due to rebound pulmonary hypertension
- Use caution with left ventricular dysfunction
RT & NBRC Mastery
Respiratory therapy exam and bedside mastery
Move from reference knowledge into board-style reasoning, adaptive practice, common distractors, and high-yield clinical scenarios.
NBRC-style question
NBRC-style pharmacology review
A patient scenario involves neonate with persistent pulmonary hypertension. Which medication concept should the respiratory therapy student recognize?
High-yield answer
iNO = pulmonary vasodilation, watch metHb
Interactive practice
The Adaptive Exam Simulator
Use the complete guide on this page to learn the medication, then switch into the adaptive simulator to test yourself with scored practice, missed-concept review, and NBRC-style clinical reasoning.
ClassPractice
MechanismPractice
Clinical usePractice
Adverse effectsPractice
ScenarioPractice
Common Exam Traps
These are the answer choices, mechanisms, or medication classes most commonly confused with this medication on RT school and NBRC-style exams.
- Bronchodilator
- Mucolytic
- Inhaled corticosteroid
- Surfactant replacement
- Beta agonist
High-Yield Clinical Scenarios
- Neonate with persistent pulmonary hypertension
- Refractory hypoxemia with pulmonary hypertension
- Question about methemoglobinemia monitoring
- Question about rebound pulmonary hypertension after abrupt discontinuation
Guidelines
Guideline-based clinical context
Connect medication facts to the larger respiratory care guidelines, disease-state recommendations, and clinical decision frameworks.
Study Tools
Practice, recall, and retention
Use mini cases, flashcards, FAQs, and related concepts to turn the medication page into a high-retention study experience.
Practice Questions
Complete question bank
Work through 0 board-style and clinical reasoning questions for this medication, organized by concept area.
Related study paths
Continue building pharmacology mastery
Use this medication page as a reference, then reinforce it with interactive practice and related PulmTools study resources.