Myocardial Infarction. You attend an emergency call to the home of Robert, a 63 year old male with a documented history of compensated congestive heart failure (CHF), who you diagnose is currently suffering a myocardial infarction. You prepare to administer GTN to Robert in the form of a sublingual spray. GTN is a potent vasodilator that works by Choose…(increasing guanylate cyclase mediated degradation of cGMP – increasing guanylate cyclase mediated production of cGMP – decreasing guanylate cyclase mediated production of cGMP – decreasing guanylate cyclase mediated degradation of cGMP) in vascular endothelial smooth muscle.
Myocardial Infarction
Prior to administering GTN, you ensure Robert has Choose…(a shockable heart rhythm – a palpable JVP – an adequate diastolic blood pressure – an adequate systolic blood pressure) and ask if he has taken any erectile dysfunction medication in the last 24hrs, to which Robert responds “the only medication he has taken in the last 24hrs is his regular Aspalgin”. On this basis you Choose…(administer GTN and monitor Roberts haemodynamics – administer double the dose of GTN to Robert – do not administer GTN to Robert – administer GTN and monitor Roberts respiratory rate) because Choose…(Aspalgin will inhibit the metabolic activation of GTN – Aspalgin is a phosphdiesterase 5 inhibitor – GTN will reduce Roberts respiratory drive – GTN will reduce Roberts blood pressure) , which may cause Robert to Choose… (experience a drug interaction resulting in uncontrolled hypotension – become hemodynamically unstable and decompensate – experience a drug interaction resulting in therapeutic failure of GTN – retain CO2 leading to respiratory failure ).
