Nitroglycerin – SBP drop by one third. Is this a 1/3 drop directly after a dose of nitroglycerin or a cumulative drop after multiple doses/sprays? My understanding was that this 1/3 drop in SBP was being used to determine the pts sensitivity to nitroglycerin. If the pt had mild/moderate SBP drops after each dose it indicated that the pt tolerated nitro well and it was safe to give higher amounts and more doses. However, a large 1/3 drop immediately after a dose of nitro meant that the pt had a high sensitivity to nitro and further tx should be discontinued for pt safety and impending hypotension. Scenario: Ischemic chest pain (Non-STEMI) with an initial SBP of 180mmHg. 1/3 dictates a drop of 60mmHg. After 4 sprays of nitro (with mild SBP drops between each dose) the pts SBP is now 115mmHg. Is this pt exempt from further nitroglycerin because cumulatively their SBP dropped by more than 1/3 OR can I continue to treat because a large 1/3 drop was not seen following an isolated spray of nitro.

How long after someone took an oral steroid (example prednisone) would be contraindicated for giving dexamethasone within the Bronchoconstriction Medical Directive? The Croup Medical Directive is clear that steroids must not have been taken within the past 48 hours. But, the Bronchoconstriction Medical Directive only says, “Currently on PO or parenteral steroids”. What is considered Currently on – taken within the last 24 hours?