NREMT Emergency Medical Technician (EMT) Cognitive ExamPharmacologyEasy
An EMT is treating a 68-year-old male presenting with chest pain. He has a history of angina and states he has taken one dose of his prescribed nitroglycerin sublingually about five minutes ago. His current blood pressure is 88/52 mmHg, and his heart rate is 110 bpm. Which of the following is the most appropriate action regarding further nitroglycerin administration?
- AWithhold further nitroglycerin and monitor vital signs.
- BAdminister another dose of nitroglycerin sublingually.
- CAdminister nitroglycerin intravenously per protocol.
- DAdminister nitroglycerin nasally.
Show answer & explanationAnswer & explanation
Correct answer: A. Withhold further nitroglycerin and monitor vital signs.
Nitroglycerin is a potent vasodilator that can significantly lower blood pressure. Given the patient's current hypotensive state (88/52 mmHg), further administration of nitroglycerin is contraindicated due to the risk of exacerbating hypotension.
Why the other options are wrong
- B. Administering more nitroglycerin would further decrease blood pressure, which is already dangerously low.
- C. EMT-level providers do not administer medications intravenously, and nitroglycerin IV is usually reserved for critical care settings, and still contraindicated with hypotension.
- D. Nitroglycerin is not typically administered nasally in the prehospital setting for chest pain; the sublingual route is preferred, but contraindicated here.
Nitroglycerin Contraindications
Conditions or situations where the administration of nitroglycerin is not recommended or is actively harmful.
- Systolic blood pressure below 90-100 mmHg
- Recent use of erectile dysfunction medications (e.g., sildenafil, tadalafil)
- Head injury
- Known hypersensitivity
Memory trick: Nitro's low BP warning: watch the pressure, not just the pain.