In patients with a history of MI or CVA, which drug-related practice should be limited?

• A. Limit Epinephrine
• B. Limit Oxygen
• C. Avoid Nitroglycerin
• D. Avoid aspirin

Answer: (A)

In patients with a history of MI or CVA, it’s important to avoid stressing the heart too much. Epinephrine stimulates the heart and vessels, increasing heart rate, blood pressure, and myocardial oxygen demand. That extra workload can provoke ischemia, trigger dangerous arrhythmias, or precipitate reinfarction in vulnerable coronary disease. Because of this risk, limiting the use of epinephrine helps protect the heart.

Oxygen is given only if the patient is actually hypoxic, and excessive oxygen can be unnecessary or even harmful in some contexts, but it isn’t the practice that should be broadly limited for this reason. Nitroglycerin and aspirin are commonly used in ischemic conditions (to relieve angina and prevent further events, respectively) and aren’t routinely limited.