26. Antianginal Drugs

Question 1

Your father has a 2 year history of stable angina he has been put on a laundry list of drugs and “ sick of this pill shit” and wants to stop. If he was taking which of the following would you tell him in no way should he abruptly stop the drug?

A. Amlodipine 
B.Sodium Nitroprusside 
C.  Verapamil 
D. Metoprolol
E. Ranolazine 

RFA

Answer 1

Ans. D. Metoprolol- a beta blocker should NEVER be stopped abruptly.

Question 2

A 52 year old man white man is has been suffering from chest pain that is exacerbated during exertion. He has smoked for 35 years and is diagnosed with COPD. An EKG shows he has a AV node block and his previous physician put him on Sodium Nitroprusside but it didn’t cause any symptom relief. Which medication would be the most appropriate treat for the man’s chest pain given his history?

A. Propranolol 
B. Isosorbide dinitrate  
C. Verapamil 
D. Metoprolol
E. Ranolazine 

RFA

Answer 2

Ans. E Ranolazine ( Na blocker that increase Ca) is the last line for angina But since he has COPD ( A & D (Beta blockers are eliminated )), Nitrates haven’t worked (eliminates B) , and the patient has a heart block which counter indicates (C)

Question 3

Which of the following anti-anginal therapies is least likely to cause reflex tachycardia? (MG)

A. Nifedipine
B. Amlodipine
C. Verapamil
D. High dose sodium dinitrate

Answer 3

C. Verapamil

Question 4

A 55 year old male is prescribed nitrates for anginal pain. He has a previous prescription for Viagra and was told to stop taking it since it can cause adverse effects if taken with his nitrates. He just really wants to bone so he disregards the physicians instructions. As a result, he becomes hypotensive and experiences impaired coronary perfusion leading to ischemic cardiac damage. Viagra and nitrates should not be used together due to the dramatic increase in what levels? (MG)

A. cAMP
B. Adenylyl cyclase
C. cGMP
D. PKC
E. PKA
F. IP3

Answer 4

C. cGMP

Viagra = sildenafil