Order: Citalopram 20 mg PO q24hr

Available: Refer to the med label below

How many milliliters will you administer per dose? (Insert the numerical value only)

A. Increased risk of arrhythmias due to drug interactions: While both drugs affect cardiovascular function, the primary risk with concurrent use is not arrhythmias. Nitroglycerin and PDE-5 inhibitors mainly influence vascular tone, not cardiac electrical activity directly.
B. Potential for life-threatening hypotension due to excessive vasodilation: Both nitroglycerin and PDE-5 inhibitors are potent vasodilators. When used together, they can cause profound hypotension due to synergistic effects on the vascular system, which may lead to syncope, myocardial infarction, or even death.
C. Increased risk of severe headache due to overlapping side effects: Headache is a known side effect of both drugs due to vasodilation, but it is not the most dangerous interaction. While uncomfortable, headaches are not life-threatening compared to the risk of severe hypotension.
D. Decreased effectiveness of nitroglycerin in relieving angina: There is no evidence that PDE-5 inhibitors reduce the efficacy of nitroglycerin. The concern is not about reduced therapeutic benefit but rather the risk of severe, potentially fatal cardiovascular side effects.

A. "I'll dial 911 if I still have pain after taking 3 nitroglycerin tablets 5 minutes apart.": While this reflects part of the correct sequence, waiting until all 3 doses are taken before seeking emergency help may delay life-saving treatment. Emergency services should be contacted sooner if the first dose is ineffective.
B. "I'll dial 911 if I still have pain after taking 4 nitroglycerin tablets over a 20-minute period.": This exceeds the recommended maximum of three sublingual nitroglycerin tablets within 15 minutes. Taking more than advised can increase the risk of hypotension and other complications.
C. "I'll dial 911 if 1 nitroglycerin tablet does not relieve my pain, and then take up to 2 more tablets 5 minutes apart while waiting.": This is the correct protocol. If chest pain persists after the first dose, the patient should immediately call 911 and may continue with up to two additional doses, each 5 minutes apart, while waiting for emergency responders.
D. "I'll dial 911 when I have pain and then take the nitroglycerin tablets.": Calling 911 immediately without trying the medication first may lead to unnecessary emergency activation. The recommended approach is to take the first dose, then call if pain persists after 5 minutes.