A 58-year-old man presents with 40 minutes of chest pain and diaphoresis. He took sildenafil 6 hours ago for erectile dysfunction. Blood pressure is 150/90 mmHg and ECG shows ST elevation in leads II, III, and aVF. Which component of initial management is absolutely contraindicated?
- A Chewed non-enteric coated aspirin 300 mg
- B Morphine sulphate intravenously
- C Sublingual glyceryl trinitrate ✓
- D Primary percutaneous coronary intervention
Correct answer: C. Sublingual glyceryl trinitrate
Explanation
Sildenafil inhibits phosphodiesterase type 5, potentiating the cyclic GMP mediated vasodilatation produced by nitrates and causing profound refractory hypotension. Nitrates are contraindicated within 24 hours of sildenafil (48 hours for tadalafil). Aspirin, opioid analgesia, and reperfusion by primary PCI remain fully indicated and should not be delayed. This interaction is a repeatedly examined pharmacological trap in ACS management questions.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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