A century ago, a factory worker related to the above patent might have presented to you complaining of severe headache, dizziness, and flushing every Monday. The symptoms would get better the next few days until they disappeared for the rest of the week. The following Monday, he would go through the same cycle.Today, you might prescribe a patient the same drug as treatment or prophylaxis for acute onset chest pain.
Challenge: What drug or chemical does this refer to?
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3 comments:
nitrates?
Nitroglycerine!
but why do the symptoms resove over the week, and recur on going to the factory again after a break?
Exactly right! Nitrates exhibit an interesting form of reversible tolerance; after several days of exposure, one becomes tolerant, but loses that tolerance after several days without exposure.
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Case of the Mondays
This case describes nitroglycerin exposure and tolerance. Individuals exposed to nitroglycerin during the production of explosives (Alfred Nobel's patent for use of nitroglycerin in explosives is shown) developed severe headache and dizziness after initial exposure. These side effects diminished after a few days, but if exposure was avoided for several days, symptoms would recur after reexposure. Hence, this happens on Monday. Sublingual nitroglycerin is also used for angina pectoris.
Sources: UpToDate; Wikipedia.
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