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Erectile dysfunction — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CareErectile dysfunctionUSMLE Step 3

A man took tadalafil 20 mg for erectile dysfunction 24 hours ago and now has an acute coronary syndrome with persistent ischemic pain despite non-nitrate therapy. Which statement about nitroglycerin is correct?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Withhold nitrates now; if lifesaving after 48 hours, administer them with hemodynamic monitoring

The best answer is “Withhold nitrates now; if lifesaving after 48 hours, administer them with hemodynamic monitoring”. Tadalafil has a prolonged interaction with nitrates. The label requires at least 48 hours before nitrate consideration in a life-threatening situation, followed by supervised hemodynamic monitoring; routine nitrate use remains contraindicated.

Reference: FDA Prescribing Information: CIALIS: https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/021368s030lbl.pdf