The Combine ( / Л€ k Й’ m ЛЊ b aЙЄ n/ COM-byne) is a multidimensional empire which serves as the primary antagonistic force in the 2004 video game Half-Life 2, and the subsequent episodes developed by Valve. In utilizing this team-oriented approach, sodium nitroprusside can be a safe and effective therapeutic option for managing acutely hypertensive patients.The Combine 'clamp' symbol, seen in propaganda throughout Half-Life: Alyx and Half-Life 2.Д®llen McLain (Overwatch announcer) Careful patient selection based on comorbidities and risk factors is required, and cliniciansВ (surgeons, anesthesiologists, intensivists) should engage in shared decision-making with their pharmacists to assess each patient's risk factors and determine an appropriate dosing protocol. Interprofessional communication is critical to the safe use of nitroprusside as these patients require intensive monitoring of hemodynamic parameters.В All members of the interprofessional healthcare team must be familiar with the potential adverse effects and toxicity syndromes. While its use has declined in recent years as newer agents have become available, this drug still has a role in treating hypertensive emergencies and other disease processes that require an urgent reduction in arterial blood pressure. Nitroprusside is a fast-acting, easily titratable, highly effective antihypertensive agent that must be used with extreme care. In contrast to nitroglycerin, nitroprusside causes a more balanced vasodilatory effect between arteries and veins. The result of this signaling cascade is peripheral vasodilation of both arteries and veins (with slightly more selectivity for veins).ДЇrom a hemodynamic perspective, the net result is a decrease in systemic vascular resistance (afterload), ventricular filling pressures, and systemic blood pressure with an increase in cardiac output.В Onset is rapid (within 2 minutes), and the duration of its hypotensive effect is roughly 10 minutes these properties make nitroprusside useful in situations requiring an immediate reduction in preload or afterload. Upon binding to vascular smooth muscle, NO triggers intracellular cGMP-mediated activation of protein kinase G and subsequent inactivation of myosin light chains, resulting in relaxation of vascular smooth muscle. Acting as a prodrug, SNP reacts with sulfhydryl groups on erythrocytes (as well as albumin and other proteins) to produce nitric oxide (NO). Sodium nitroprusside is a water-soluble salt comprised of ferrous iron complexed with nitric oxide (NO) and five cyanide ions. Sodium nitroprusside has the following FDA-approvedВ indications: While sodium nitroprusside'sВ potential adverse effects and toxicity have led to its replacement by newer agents in some practices, itВ remains aВ useful toolВ in certain difficult clinical situations that require a potent, fast-acting, titratable vasodilator. After an initial delay in gainingВ FDA approval due toВ difficulty in the development of a chemically stable formulation,В SNP gained widespread use as a fast-acting antihypertensive agent and has been used clinically for hypertensive crises, heart failure, cardiac/vascular surgery, pediatric surgery, and a variety of other acute applications.

First discovered in 1849 by Playfair, its applications in human medicine can be traced back to the early 1920s, with the first safety and efficacy data published in 1955. Sodium nitroprusside (SNP) is a potent vasodilator that first gained FDA approval for the treatment of severe hypertension in 1974.

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