In a normotensive patient (SBP >100), which medication should be administered?

In a normotensive patient (SBP >100), which medication should be administered?

• A. Aspirin
• B. Nitroglycerin 0.4 mg SL; may repeat q5min as long as HR >60 and SBP >100
• C. Nitroglycerin 0.8 mg SL
• D. Furosemide IV

Answer: (B)

In this scenario, the key concept is using vasodilator therapy to relieve ischemia only when the patient’s blood pressure and heart rate indicate it is safe to do so. Nitroglycerin is given sublingually to reduce myocardial oxygen demand by decreasing preload and afterload and to improve coronary perfusion. The recommended dose is 0.4 mg, with the option to repeat every 5 minutes if the patient’s systolic blood pressure remains above 100 and heart rate remains above 60. This ensures we continue to relieve ischemia without dropping the blood pressure too low or causing dangerous hypotension or reflex complications. The alternative dose of 0.8 mg is not standard and carries a higher risk of hypotension. Furosemide is not appropriate here unless there are signs of fluid overload or pulmonary edema. While aspirin is commonly used in suspected ACS, the question focuses on the nitroglycerin management based on hemodynamic status, and nitro is the targeted choice given SBP >100 and HR >60.

In this scenario, the key concept is using vasodilator therapy to relieve ischemia only when the patient’s blood pressure and heart rate indicate it is safe to do so. Nitroglycerin is given sublingually to reduce myocardial oxygen demand by decreasing preload and afterload and to improve coronary perfusion. The recommended dose is 0.4 mg, with the option to repeat every 5 minutes if the patient’s systolic blood pressure remains above 100 and heart rate remains above 60. This ensures we continue to relieve ischemia without dropping the blood pressure too low or causing dangerous hypotension or reflex complications. The alternative dose of 0.8 mg is not standard and carries a higher risk of hypotension. Furosemide is not appropriate here unless there are signs of fluid overload or pulmonary edema. While aspirin is commonly used in suspected ACS, the question focuses on the nitroglycerin management based on hemodynamic status, and nitro is the targeted choice given SBP >100 and HR >60.