Question: Can you clarify a condition in the contraindications for nitro use protocols? Current contraindications listed under the protocol are self explanatory, where as one to me seems to be very vague. The one Im referring to is the use of a "Phosphodiesterase Inhibitors" within the previous 48 hours. They are many examples of this type of inhibitor (including caffeine) and it might reduce confusion if the specific and relevant ones were listed under the protocol specific to cardiac. For example, a patient who has had a cup of coffee prior to your arrival or 48 hours prior to for that matter has ingested a Phosphodiesterase Inhibitor. Under the current directive and the way it is written, could be argued that this patient is contraindicated to receive Nitro.

 The medical directives attempts to not use brand names of medications. As such, the class of medications used for erectile dysfunction is the intended target of the contra-indication for Nitro. Clearly, a cup of coffee is not a contra-indication for Nitro administration. With every medical directive, it is possible to extrapolate to extreme or rare circumstances where the directive is not specific enough. It is a balance when creating these directives between the size of the protocol book and the prescriptive minutia in the details vs common sense.

The other issue is that these phosphodiesterase inhibitor drugs are also used for pulmonary hypertension. This is why we had to change it from ED drugs and expand the list of names Sildenafil (Viagra, and Revatio), tadalafil, (Cialis, Adcirca), vardenafil (Levitra) even though they are the same drug. The patient may not know they are on Viagra, as they may use the second name in each case.

Acute Cardiogenic Pulmonary Edema,Cardiac Ischemia,Cardiac/Circulation

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