NAPLEX (North American Pharmacist Licensure Examination) Practice Exam

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For PAH, which class of medication is NOT recommended in combination with nitrates?

  1. Prostacyclin analogues

  2. Endothelin receptor antagonists

  3. Phosphodiesterase-5 inhibitors

  4. Soluble guanylate cyclase stimulators

The correct answer is: Phosphodiesterase-5 inhibitors

Nitrates work by dilating blood vessels to improve blood flow. Phosphodiesterase-5 (PDE-5) inhibitors, such as sildenafil and tadalafil, also dilate blood vessels. Combining nitrates with PDE-5 inhibitors can cause severe hypotension as both medications lower blood pressure, making this combination unsafe. Therefore, PDE-5 inhibitors are not recommended in combination with nitrates for patients with pulmonary arterial hypertension (PAH). On the other hand, prostacyclin analogues, endothelin receptor antagonists, and soluble guanylate cyclase stimulators are often used in conjunction with nitrates for the treatment of PAH.

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