Patients taking which cholesterol-lowering agent may require supplements of fat-soluble vitamins A, D, E, and K?

The correct answer is Choice D: Headache.

Choice A rationale: Nausea is not a common adverse effect of sublingual nitroglycerin. Nausea may occur in some patients, but it is usually mild and transient.Nausea may be related to the vasodilatory effects of nitroglycerin, which can cause hypotension and reflex tachycardia1. Nausea may also be caused by other factors, such as anxiety, stress, or food intolerance.Nausea is not a specific indicator of nitroglycerin toxicity or overdose2.

Choice B rationale: Bradycardia is not a common adverse effect of sublingual nitroglycerin. Bradycardia is a slow heart rate, usually defined as less than 60 beats per minute.Bradycardia may occur in some patients who take nitroglycerin, especially in combination with other drugs that affect the heart rate, such as beta-blockers, calcium channel blockers, or digoxin3. Bradycardia may also be caused by other factors, such as vagal stimulation, hypothyroidism, or electrolyte imbalance.Bradycardia is not a specific indicator of nitroglycerin toxicity or overdose2.

Choice C rationale: Hypertension is not a common adverse effect of sublingual nitroglycerin. Hypertension is a high blood pressure, usually defined as more than 140/90 mmHg.Hypertension may occur in some patients who take nitroglycerin, especially in those who have a history of hypertension, renal impairment, or volume overload4. Hypertension may also be caused by other factors, such as stress, pain, or caffeine intake.Hypertension is not a specific indicator of nitroglycerin toxicity or overdose2.

Choice D rationale: Headache is a common adverse effect of sublingual nitroglycerin.Headache may occur in up to 80% of patients who take nitroglycerin, especially during the first few days of therapy or after an increase in dose5. Headache may be related to the vasodilatory effects of nitroglycerin, which can cause cerebral vasodilation and increased intracranial pressure. Headache may also be caused by other factors, such as dehydration, sinusitis, or migraine. Headache is usually mild to moderate in intensity and can be relieved by analgesics, such as acetaminophen or aspirin.Headache is not a specific indicator of nitroglycerin toxicity or overdose

This is because digoxin inhibits the Na-K-ATPase pump on the membrane of cardiac cells, which can cause extracellular potassium levels to rise.Hypokalemia (low potassium) caused by large dosages of diuretics may result in digoxin toxicity even at low serum digoxin levels.Digoxin toxicity can cause gastrointestinal, constitutional, and/or cardiovascular symptoms, as well as ECG changes such as signs of increased automaticity and atrioventricular node blockade.

Choice B is wrong because calcium 9.2 mg/dL is within the normal range of 8.5 to 10.5 mg/dL.Hypercalcemia (high calcium) can increase sensitivity to digoxin effects and lead to toxicity even with a lower concentration of serum digoxin, but this is not the case here.

Choice C is wrong because potassium 4.8 mEq/L is within the normal range of 3.5 to 5.0 mEq/L.

Hyperkalemia (high potassium) can also increase the risk of digoxin toxicity, but this is not the case here.

Choice D is wrong because calcium 10.3 mg/dL is within the normal range of 8.5 to 10.5 mg/dL.Hypercalcemia (high calcium) can increase sensitivity to digoxin effects and lead to toxicity even with a lower concentration of serum digoxin, but this is not the case here.