A patient arrives at the hospital emergency department via EMS, complaining of being “lightheaded”. The patient has a heart rate of 42 and BP 90/50 mmHg.

What medication should the RN anticipate being prescribed and administered immediately?

Choice A rationale:

Sildenafil (Viagra) is a phosphodiesterase-5 (PDE-5) inhibitor that is primarily used to treat erectile dysfunction. However, it also has vasodilatory effects, meaning it widens blood vessels. This can lead to a significant drop in blood pressure, especially when combined with nitroglycerin, another potent vasodilator.

Nitroglycerin is commonly used to treat chest pain (angina) and heart failure. It works by relaxing the smooth muscles in blood vessels, which allows them to widen and increase blood flow to the heart. This can help to relieve chest pain and improve heart function.

When sildenafil and nitroglycerin are taken together, their combined vasodilatory effects can cause a severe drop in blood pressure, known as hypotension. This can lead to a number of serious complications, including: dizziness, lightheadedness, fainting, heart attack, stroke.

The risk of hypotension is particularly high in patients who are already taking other medications that can lower blood pressure, such as alpha-blockers or nitrates. It is also important to note that the effects of sildenafil can last for up to 24-48 hours, so it is important to avoid taking nitroglycerin within this timeframe.

Due to the significant risk of hypotension, it is generally recommended that sildenafil be avoided within 24-48 hours of nitroglycerin administration.

Rationales for other choices:

Choice B: Aspirin

Aspirin is an antiplatelet medication that is often used to prevent blood clots. It does not have significant vasodilatory effects and does not interact with nitroglycerin in a way that would contraindicate its use.

Choice C: Adenosine

Adenosine is a medication that is used to treat certain types of arrhythmias (irregular heartbeats). It can cause a brief drop in blood pressure, but this effect is usually mild and transient. Adenosine does not interact with nitroglycerin in a way that would contraindicate its use.

Choice D: Oxygen

Oxygen is a gas that is often used to treat patients with respiratory problems. It does not have any direct vasodilatory effects and does not interact with nitroglycerin.

Choice A rationale:

Insulin is a protein-based hormone that is sensitive to heat and light. Exposure to high temperatures or direct sunlight can cause insulin to break down and become less effective.

Refrigeration helps to maintain the stability and potency of insulin. It is generally recommended to store unopened insulin vials in the refrigerator at a temperature between 36°F and 46°F (2°C and 8°C).

This temperature range helps to slow down the degradation process and ensure that the insulin remains effective until its expiration date.

Choice B rationale:

Insulin should never be frozen. Freezing can cause the insulin to crystallize and become unusable. Once insulin has been frozen, it cannot be thawed and used again.

Choice C rationale:

Opened vials of insulin do not need to be discarded immediately. They can be stored in the refrigerator for up to 28 days, depending on the type of insulin.

However, it is important to note the date that the vial was opened and to discard it after the recommended storage period.

Choice D rationale:

Insulin pens should be stored according to the manufacturer’s instructions. Some insulin pens can be stored at room temperature for a certain period of time, while others must be refrigerated.

It is important to read the instructions that come with the insulin pen to ensure that it is stored properly.