SBA — Single Best Answer · Review
Question 447
Pharmacology → General
Classification
Question
SSBAQuestion Header
A medication review identifies several potentially important drug combinations. Which combination is specifically associated with profound hypotension?
Question Stem
Select the single best answer.
Options
A
Sildenafil with isosorbide mononitrate
B
A statin with a fibrate
C
Metronidazole with alcohol
D
Phenytoin with rifampicin
E
Fluconazole with erythromycin
Explanation
Combining sildenafil with isosorbide mononitrate may cause profound hypotension. It separately associates statin-fibrate combinations with increased risk of myositis and metronidazole with alcohol with a disulfiram-like reaction.
Option Validity
B) Statin plus fibrate therapy is associated with an increased risk of myositis rather than profound hypotension.
C) Metronidazole with alcohol is associated with a disulfiram-like reaction including nausea, vomiting and flushing.
D) Phenytoin and rifampicin are both hepatic microsomal enzyme inducers; profound hypotension is not the interaction highlighted for this pair.
E) Fluconazole and erythromycin are enzyme inhibitors and are not the combination responsible for profound hypotension.
Further Reading
Saxena R. Textbook for MRCOG-1. Chapter 12: Pharmacology. Clinical Pharmacy, pp.344–345.