A 55-year-old man takes sildenafil regularly for erectile dysfunction. He presents to the emergency department with severe chest pain and is found to have an anterior STEMI. Which antianginal agent must be avoided in this patient?

• A Intravenous metoprolol
• B Sublingual glyceryl trinitrate ✓
• C Aspirin 300 mg chewed
• D Morphine sulfate

Explanation

Nitrates are absolutely contraindicated within 24 hours of sildenafil and 48 hours of tadalafil. Phosphodiesterase type 5 inhibition raises cyclic GMP in vascular smooth muscle, and adding a nitric oxide donor produces profound, refractory hypotension. Beta blockers, aspirin, and morphine carry no such interaction and remain part of routine STEMI care. This interaction is a frequently examined emergency medicine point.

Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.