Case Study: A 65-year-old man with a past medical history of hypertension, hyperlipidemia, type 2 diabetes, and coronary artery disease presents to the hospital with an acute onset of chest pain. The patient describes his chest pain as crushing, worse with exertion, relieved with rest, and not reproducible with palpation. On physical exam, the patient is diaphoretic, and cardiac is notable for regular S1 and S2 without additional sounds. There is no jugular venous distension or peripheral edema, and also no crackles are heard on the lung exam. EKG shows acute ST-T wave changes in the anterior and lateral leads concerning ischemia. Serum troponin level is elevated. The nursing staff is called to administer nitroglycerin to the patient by the physician in the emergency department.
1. Which of the following is the most appropriate route of administration to achieve the drug’s efficacy the fastest and avoid the extensive first-pass metabolism?
2. Explain first-pass and what routes of admission are not affected by first-pass.
3. Explain bioavailability and give an example.
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