Editing Pharmacology – RN Practice Questions (section)

==Question 8==
A client with chest pain is admitted for a nitroglycerin infusion. During the medication history, the client states he took sildenafil approximately 12 hours ago. Which action is the priority?
# Start the nitroglycerin infusion at the lowest ordered rate and monitor blood pressure
# Hold the nitroglycerin and notify the provider immediately
# Administer the nitroglycerin with a normal saline bolus to prevent hypotension
# Give sublingual nitroglycerin instead of the infusion

'''Answer:''' 2 (B) Hold the nitroglycerin and notify the provider immediately.

''Rationale:'' Nitrates in any form are contraindicated within roughly 24 hours of sildenafil and roughly 48 hours of tadalafil. Combining them causes profound, refractory hypotension and cardiovascular collapse. The nurse holds the drug and communicates with the provider so an alternative anti-ischemic strategy can be chosen. Options 1, 3, and 4 all deliver a nitrate and are unsafe; the route does not remove the interaction, and a fluid bolus does not reliably prevent the hypotension.