59.陳先生53歲，服用下列藥品：nitroglycerin (NTG) 0.6 mg/tab 1 tab SL prn；isosorbide dinitrate 10 mg/tab 1 tab tid；metoprolol 50 mg/tab 1 tab tid。有關用藥指導，下列何者正確？
(A)服用NTG 24小時後，就可以安全的使用vardenafil
(B)應提醒病人避免服用sildenafil
(C)應提醒病人若發生頭痛的副作用要立即請醫師改藥
(D)為確保療效，isosorbide dinitrate和metoprolol 一定要照時間服藥，一天三次，三餐飯後服用

Dinitrate : TID ( 7am、noon、5pm )
Mononitrate : BID (睡醒、睡醒7hr後)

sildenafil、vardenafil隔24 hrs

taladafil隔48 hrs

Administration 

Do not administer around the clock; allow nitrate-free interval ≥14 hours (immediate release products) and >18 hours (sustained release products). Do not chew or crush sublingual tablets or sustained release formulations.

Immediate release products: For twice daily dosing, consider administering at 8 AM and 1 PM. For 3 times daily dosing, consider 8 AM, 1 PM, and 6 PM.

Sustained release products: Consider once daily in morning or twice-daily dosing at 8 AM and between 1 PM and 2 PM

Uptodate：Isosorbide dinitrate Drug information

請問若照題目敘述「isosorbide dinitrate 10 mg/tab 1 tab tid；metoprolol 50 mg/tab 1 tab tid」

則(D)照時間服藥，一天三次，三餐飯後服用 

為什麼錯誤~~?

由於Vardenafil與硝酸鹽類合併使用對病人造成降血壓作用的資料尚未建立，因此禁止與硝酸鹽類併用。