Question

A 49-year-old male with an extensive cardiac history presents with 2 hours of crushing chest pain and shortness of breath. He is pale and diaphoretic and tells you that he feels like he is going to die. His medications include nitroglycerin, sildenafil (Viagra), and enalapril (Vasotec). His blood pressure is 140/90 mm Hg and his heart rate is 110 beats/min. In addition to administering supplemental oxygen if needed, you should:

A. obtain physician approval to give the nitroglycerin.
B. place him in a supine position and transport at once.
C. administer one nitroglycerin and call medical control.
D. ask him if he took his Viagra within the past 24 hours.

Answer 1

The most appropriate action is to ask the patient if they have taken sildenafil in the past 24 hours due to the possible severe drug interaction that could result if nitroglycerin is administered. Administering nitroglycerin to a patient who has taken sildenafil can lead to potentially dangerous hypotension.

Step-by-step explanation:

In this scenario, the most appropriate action would be to first ask the patient if they have taken sildenafil (Viagra) within the past 24 hours. Due to potential drug interactions between nitroglycerin and sildenafil, it can be dangerous to administer nitroglycerin without confirming the timing of the sildenafil dose. Sildenafil is a phosphodiesterase-5 (PDE5) inhibitor and can enhance the effects of nitrates, such as nitroglycerin, leading to potentially life-threatening hypotension (low blood pressure). Given that the patient’s current medications include both nitroglycerin (for angina pectoris) and sildenafil (for erectile dysfunction), it is vital to ensure there is no risk of interaction before administering further nitroglycerin for the management of his chest pain.

Immediate treatments for myocardial infarction (MI) are crucial, and they generally include administering supplemental oxygen, aspirin to help break up clots, and nitroglycerin to facilitate its absorption and provide vasodilation. However, in the case of this particular patient, who has a history of cardiac issues and is currently on sildenafil, administering nitroglycerin without knowing when the last dose of sildenafil was taken could be harmful due to the drop in blood pressure it may cause.