Question
A 54-year-old man with a history of hypertension and hyperlipidemia comes to the physician because of a 10-month history of substernal chest pain on exertion that is relieved with rest. His pulse is 82/min and blood pressure is 145/82 mm Hg. He is prescribed a drug that acts by forming free radical nitric oxide. The patient is most likely to experience which of the following adverse effects as a result of this drug?
| A. |
Pulsating headaches
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| B. |
Digital vasospasm
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| C. |
Hypertensive urgency
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| D. |
Nonproductive cough
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Show Answer
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Correct Answer � A
Explanation
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Ans-A-Pulsating headaches
Pulsating headaches
Headaches are a common side effect of nitrates and affect approx. 10% of patients. These headaches are either mild-to-moderate and occur immediately after drug administration (due to nitric oxide-induced vasodilation) or migraine-like, occurring several hours after drug intake (due to nitric oxide-mediated release of neurotransmitters such as calcitonin gene-related peptide and glutamate, and/or altered ion channel function). Nitrate-induced vasodilation decreases both preload and afterload and improves myocardial perfusion, but may also result in cutaneous flushing and hypotension.
Other adverse effects include gastroesophageal reflux and reflex tachycardia, the latter of which can be treated with beta blockers.
Digital vasospasm
Digital vasospasm (secondary Raynaud phenomenon) is a potential side effect of beta blockers. This side effect is mediated by the blockade of beta blockers on ß2-receptors, which causes vasoconstriction. Nitrates do not cause digital vasospasm.
Hypertensive urgency
Nitrates can cause hypotension, rather than hypertensive urgency. Nitrates are used to treat hypertensive crisis for short-term reduction of blood pressure and are contraindicated in hypotensive patients.
Nonproductive cough
Nonproductive cough is a side effect of ACE inhibitors. This side effect is due to decreased breakdown of bradykinin, which increases production of arachidonic acid metabolites (e.g., prostaglandins). The accumulation of prostaglandins in the upper respiratory tract and the lungs results in nonproductive cough. Nitrates do not cause cough.
