The Correct Answer is B!

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A 66 year-old man presents to the emergency room with 3 hours of chest pain. He is given a sublingual nitroglycerin, and his BP falls to 60 mmHg with near syncope. He now admits to having taken sildenafil an hour before the onset of chest pain. 

What is the mechanism of his hypotension?

  1. Endothelial-independent vasodilation
  2. Excess cGMP mediated vasodilatation
  3. Decreased production of thromboxane synthetase
  4. Increased levels of prostaglandin (PG12)

Answer Rationale:

Nitrates taken with PDE5 inhibitors produce excess cGMP mediated vasodilation due to an increase in nitric oxide which enhances the guanylate-cylcase conversion of GTP to cGMP.

1.  Source: "Comparative Analysis of Pre/Post Assessments of Live/Didactic Course Attendees when compared to Mico-Learning/Online Course Users., "Knowledge to Practice, 2017.

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