Which drug class should not be used when a patient is taking nitrates?

Simvastatin is a type of drug called a statin, which lowers cholesterol and triglycerides in the blood. Statins work by reducing the amount of cholesterol made by the liver, and the liver produces more cholesterol at night.Therefore, taking simvastatin in the evening can increase its effectiveness.

Choice A is wrong because changing position slowly when rising from a chair is not related to simvastatin use.

This advice is usually given to people who have low blood pressure or take medications that lower blood pressure, such as diuretics or beta blockers.

Choice B is wrong because maintaining a steady intake of green leafy vegetables is not specific to simvastatin use.

This advice is usually given to people who take anticoagulants, such as warfarin, because green leafy vegetables contain vitamin K, which can affect the blood clotting process.

Choice C is wrong because consuming no more than 1 L/day of fluid is not related to simvastatin use.

This advice is usually given to people who have fluid retention or heart failure, because excess fluid can put strain on the heart and lungs.

PT stands for prothrombin time, which is a measure of how long it takes the blood to clot.

INR stands for international normalized ratio, which is a way of standardizing the PT results across different laboratories.

Warfarin is a blood thinner that works by inhibiting the production of vitamin K-dependent clotting factors in the liver.

Therefore, warfarin prolongs the PT and increases the INR.The PT/INR test is used to monitor the effectiveness of warfarin therapy and adjust the dose accordingly.

Choice A is wrong because PTT stands for partial thromboplastin time, which is another measure of blood clotting time, but it reflects the activity of different clotting factors than PT.PTT is used to monitor heparin therapy, not warfarin therapy.

Choice C is wrong because aPTT stands for activated partial thromboplastin time, which is a variation of PTT that uses an activator to speed up the clotting time.Like PTT, aPTT is used to monitor heparin therapy, not warfarin therapy.

Choice D is wrong because ACT stands for activated clotting time, which is a measure of the whole blood clotting time.ACT is used to monitor high-dose heparin therapy during certain procedures, such as cardiac bypass surgery or angioplasty.

The normal ranges for these tests may vary depending on the laboratory and the method used, but generally, they are:

• PT: 10 to 13 seconds

• INR: 0.8 to 1.2 (without warfarin) or 2.0 to 3.0 (with warfarin)

• PTT: 25 to 35 seconds

• aPTT: 30 to 40 seconds

• ACT: 70 to 120 seconds