A 60-year-old amn is being evaluated for occasional pain the chest which resolves with sublingual nirtoglycerin. He has a chronic stable angina and hypertesnion for which he takes multiple medications for his conditions.Blood pressure is 140/80 mm Hg and pulse is 68/min and regular. Examination reveals normal heart sounds. While discussing a plan to start isosorbide dinitrate therapy, the patient becomes concerned about the high dose of oral isosorbide dinitrate compared to sublingual nitroglycerin. Which of the following is the most likely reason for using a high dose of oral nitrate?

Question

A 60-year-old amn is being evaluated for occasional pain the chest which resolves with sublingual nirtoglycerin. He has a chronic stable angina and hypertesnion for which he takes multiple medications for his conditions.Blood pressure is 140/80 mm Hg and pulse is 68/min and regular.  Examination reveals normal heart sounds.  While discussing a plan to start isosorbide dinitrate therapy, the patient becomes concerned about the high dose of oral isosorbide dinitrate compared to sublingual nitroglycerin.  Which of the following is the most likely reason for using a high dose of oral nitrate?

Quizplus · Accepted Answer

Eductional Objective: Isosorbide dinitrate has a low bioavailability due to extensive first-pass hepatic metabolism prior to release in systemic circulation.  Sublingual nitroglycerin is absorbed directly from oral mucosa into the venous circulation and has a higher bioavailability.

A 60-Year-Old Amn Is Being Evaluated for Occasional Pain the Chest