Questions – Angina and Heart Failure Management

by Pravin Shukle, MD

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    Let's move on to some questions. First question, a 60 year old man has high blood pressure. He presents to the ER with chest pains radiating into the left arm. He had chest pain while he was having sexual intercourse. He had taken some Viagra earlier that evening. The nurse practitioner on call in the emergency department gave some nitroglycerin to the patient. Now that you shown up, you see that the blood pressure is 66/30. How and why did this happen? A, it was an interaction at the monoamine oxidase pathway causing excess tyramine. B, an interaction at the nitric oxide pathway, causing direct vasodilation. C, excess cGMP causing direct vasodilation. D, the patient appears to have been poisoned with cyanide. Or E, this appears to be a drug allergy. Which one is the most correct? Good, you chose C, excess cyclic GMP causing direct vasodilation. Let's take a look at each of the potential answers and figure out why each one was right or wrong. So, A is not correct, this has nothing to do with monoamine oxidase. It is true that you can have an interaction between a monoamine oxidase and tyramine rich foods like wine and cheese, and that can cause severe hypertension, not low blood pressure. B is wrong. Interaction at the nitric oxide pathway causing direct vasodilation. That's not quite right. It's kind of true but not really. And it would be one of those things that you might choose if you didn't have C, which is excess cyclic GMP. The major reason why these two drugs react so badly to each other is that the nitrates are causing more cyclic GMP production and the PDE5 inhibitors are reducing cyclic GMP breakdown, so there is tons and tons and tons of cyclic GMP, and...

    About the Lecture

    The lecture Questions – Angina and Heart Failure Management by Pravin Shukle, MD is from the course Cardiovascular Pharmacology. It contains the following chapters:

    • Question 1: Heart Failure
    • Question 2: Heart Failure
    • Question 3: Heart Failure

    Author of lecture Questions – Angina and Heart Failure Management

     Pravin Shukle, MD

    Pravin Shukle, MD

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