In acute myocardial infarction which drug is administered sublingually and intravenously?

AIIMS Raipur NO- 2019 (shift 3rd)

Pharmacology

Medium

Appeared in: AIIMS Raipur NO- 2019 (shift 3rd)

Explanation

Nitroglycerin is a potent vasodilator used to treat chest pain in acute myocardial infarction (AMI).
It is administered sublingually (under the tongue) for rapid onset of action (1-3 minutes) to relieve acute anginal attacks.
If sublingual doses are ineffective or if continuous vasodilation is required (e.g., for persistent ischemia, hypertension, or heart failure), an intravenous infusion is initiated.
This dual-route capability makes it unique among the initial drugs used for AMI management, allowing for both rapid and sustained therapeutic effects.

Option A: Aspirin's primary role in AMI is antiplatelet therapy. For rapid effect, it is administered orally and chewed to promote faster buccal absorption, not sublingually.
Option C: Atenolol is a beta-blocker used to reduce myocardial oxygen demand. It is given intravenously to stable patients for rapid effect, followed by oral maintenance therapy. It is not administered sublingually.
Option D: Morphine is an opioid analgesic used for severe chest pain in AMI that is not relieved by nitroglycerin. Its standard route of administration is intravenous to ensure reliable and rapid pain relief.

Clinical Relevance

Nursing practice connection: Knowing Pharmacological management of Acute Myocardial Infarction (AMI) and drug administration routes helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
A nurse's primary responsibility during nitroglycerin administration is continuous blood pressure monitoring due to the high risk of hypotension.
Understanding the different routes is crucial: sublingual is for acute, rapid relief, while intravenous is for sustained, controlled management of persistent ischemia.
Patient education is key: The nurse must instruct the patient on how to take sublingual tablets and inform them about common side effects like headache and dizziness.

How to Approach the Question

First, identify the core of the question: it asks for a single drug used in AMI that has two specific routes of administration - sublingual AND intravenous.
Review each option and recall the standard administration protocol for that drug in the context of an AMI.
Evaluate Aspirin: It's chewed (oral/buccal), not sublingual. Eliminate.
Evaluate Nitroglycerin: It's given sublingually for acute pain and can be given intravenously for persistent pain. This matches both criteria.
Evaluate Atenolol: It's given IV and then orally, not sublingually. Eliminate.
Evaluate Morphine: It's given intravenously, not sublingually. Eliminate.

Concept Tested & Keywords

Concept Tested: Pharmacological management of Acute Myocardial Infarction (AMI) and drug administration routes.
Stem keywords: acute myocardial infarction, drug, administered
Lead-in keywords: sublingually and intravenously

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E6 Medicine Harrison 22e Part 2 pp. 22-24, 13-15

E6 Pharmacology Nurses Shanbhag 3e p. 112-114