Скачать или смотреть Viagra: The Pill That Can Make a Heart Attack Treatment Deadly

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🌟A 68-year-old male with a history of stable angina presents to the emergency department with severe, crushing chest pain. His blood pressure is 105/70 mmHg, and his heart rate is 90 bpm. You suspect an acute coronary syndrome. As per protocol, you plan to administer sublingual nitroglycerin.
Before giving the nitroglycerin, which of the following questions is absolutely mandatory to ask the patient to prevent a life-threatening complication?
a) "Have you taken any aspirin in the last 24 hours?"
b) "Have you recently taken any medication for erectile dysfunction, like sildenafil (Viagra)?"
c) "Are you allergic to morphine?"
d) "Have you had any recent changes to your blood pressure medication?"
===
The correct answer is b) "Have you recently taken any medication for erectile dysfunction, like sildenafil (Viagra)?"
This question tests the knowledge of the single most dangerous and absolutely contraindicated drug interaction with nitrates.
(b) "Have you recently taken any medication for erectile dysfunction, like sildenafil (Viagra)?" This is the correct answer.
Mechanism of Nitrates: Nitroglycerin works by donating nitric oxide (NO), which leads to the production of cyclic GMP (cGMP). cGMP is a powerful vasodilator, causing veins and arteries to relax, which reduces the workload on the heart and relieves angina.
Mechanism of Sildenafil: Sildenafil (Viagra) is a phosphodiesterase-5 (PDE-5) inhibitor. Its job is to prevent the breakdown of cGMP, thereby enhancing its vasodilatory effect to facilitate an erection.
The Deadly Interaction: When a patient takes both drugs, their mechanisms become synergistic. Nitroglycerin massively increases the production of cGMP, while sildenafil completely blocks its breakdown. This leads to a profound and unstoppable accumulation of cGMP, causing catastrophic, refractory vasodilation. The patient's blood pressure can plummet to dangerously low levels, leading to severe hypotension, shock, and potentially death. This is an absolute contraindication. The standard rule is to avoid nitrates for at least 24 hours after sildenafil use.
High-Yield Takeaway: Before administering nitrates to any patient with chest pain, you must ask about recent use of PDE-5 inhibitors (sildenafil, tadalafil, vardenafil). This is one of the most critical safety questions in emergency medicine..
#viagra
#sildenafil
#contraindications
Professor Armen Astvatsatryan, MD, PhD, ScD, FESC. First Dean and Founder of Faculty of Public Health of European Regional Educational Academy (now University). One of 100 of the International Biographical Center`s (Cambridge, England) Top Health Professionals - 2007.
[email protected]
  / armenastvatsatryan