Antianginal Drugs 💊

Question 1

Episodes of chest pain associated with exertion

Answer 1

Stable angina

Question 2

It occurs at rest with increasing frequency and
duration of attacks)

Answer 2

Unstable angina

Question 3

It occurs at rest due to spasm of coronary arteries

Answer 3

Prinzmetal’s Angina

Question 4

What is the mechanism of action of B-blockers ?

atenolol, bisoprolol, metoprolol , propanolol

Answer 4

Decreasing the afterlaod

Question 5

B-blockers are contraindicated in which type of angina?

Answer 5

Prinzmetal angina

Question 6

Which type of medication effect is Negative Inotropic, Chronotropic & Dromotropic effect

Answer 6

Calcium channels blockers

Question 7

Which type of calcium channels blockers work mainly on the arteriolar vasculature decreasing afterload.
And can be combined with beta blockers?

Answer 7

Dihydropyridines (DHPs): Ex. Nifedipine, amlodipine,

Question 8

can be used to treat prinzmetal’s angina.

Answer 8

Diltiazem

Non-dihydropyridines calcium channel blocker

Question 9

CI /Drug interaction: Beta-blockers in combination with

Answer 9

Non-dihydropyridines: verapamil, diltiazem.
Cardiac arrest , AV block , bradycardia

Question 10

Mechanism of action of organic nitrate ?

Answer 10

Decreasing the after and pre load

Question 11

has its main effect on cardiac conduction and weak vasodilation?

Answer 11

Non-dihydropyridines: verapamil, diltiazem.

Question 12

dilation of the large veins, which
reduces preload (venous return to the heart) and, therefore, reduces the
work of the heart.
also dilate the coronary vasculature,

Answer 12

Nitroglycerin

Question 13

Most common side effect of nitrate?

Answer 13

Headache

Question 14

Which type of nitrate used for chronic use ?

Answer 14

Isosorbide mononitrate

Question 15

It is most often used in patients who have failed other antianginal
therapies.

Answer 15

Ranolazine sodium channels blockers

Question 16

Which medication should be prescribed to all angina patients to treat an acute attack?
A. Isosorbide dinitrate
B. Nitroglycerin patch
C. Nitroglycerin sublingual tablet or spray
D. Atenolol

Answer 16

Nitroglycerin sublingual tablet or spray

Question 17

A 65-year-old male experiences uncontrolled angina attacks that limit his ability to do household chores. He is adherent to a maximized dose of β-blocker with a low heart rate and low blood pressure. He was unable to tolerate an increase in isosorbide mononitrate due to headache. Which is the most appropriate replacment to his antianginal therapy? A. Amlodipine. B. Aspirin. C. Ranolazine. D. Verapamil.

Answer 17

Ranolazine

Question 18

A 76-year-old man with uncontrolled hypertension is experiencing typical angina pain that is relieved with rest and sublingual nitroglycerin. He has a high blood pressure (178/92 mm Hg) and a low heart rate (54 bpm). Which is the most appropriate therapy for his angina at this time? A. Ranolazine B. Verapamil C. Metoprolol D. Amlodipine

Answer 18

Amlodipine
Work on vessle and would cause vasodilation to lower the blood pressure without lowering the heart rate more

Question 19

Good or Bad Combinations

A (DHP) calcium channel blocker and a beta-blocker (coronary
vasodilation, decreased afterload, lower heart rate, suppression of
reflex tachycardia)

Answer 19

Good

Question 20

Good or Bad Combinations

A nitrate and a beta-blocker (coronary vasodilation, decreased
preload, lower heart rate, suppression of reflex tachycardia)

Answer 20

Good

Question 21

Good or Bad Combinations

A nitrate and a (non-DHP) calcium channel blocker (coronary
vasodilation, decreased preload and afterload, lower heart rate,
suppression of reflex tachycardia)

Answer 21

Good

Question 22

Good or Bad Combinations

A nitrate, a DHP calcium channel blocker, and a beta-blocker
(coronary vasodilation, decreased preload and afterload, lower heart
rate, suppression of reflex tachycardia)

Answer 22

Bad

Question 23

Good or Bad Combinations
A beta-blocker and non-dihydropyridine calcium channel blocker
(bradycardia, AV block, depressed LV function).

Answer 23

Bad

Question 24

Nitroglycerin is commonly administered via the
sublingual or transdermal route (patch or ointment)
Why?

Answer 24

To avoid hepatic first pass effect

Question 25

drug of choice for prompt relief of an angina attack precipitated by exercise or emotional stress.

Answer 25

Sublingual nitroglycerin

Question 26

Nitrate are contraindicated with ?

Answer 26

Phosphodiesterase type 5 inhibitors such as **sildenafil** potentiate the action of the nitrates (sever hypotension).

Question 27

What kind of beta blockers must be avoided with patients with angina and a history of MI

Answer 27

intrinsic sympathomimetic activity (ISA) such as pindolol

Question 28

What kind of calcium channel blockers increases digoxin levels

Answer 28

Verapamil

Question 29

Significant Side effect of verapamil?

Answer 29

Constipation

Question 30

Nitrates increase concentrations of ?

Answer 30

cGAMP

Question 31

A 64-year-old man was prescribed atenolol and sublingual nitroglycerin after his recent hospitalization for unstable angina. Which of his current medications should be discontinued? A. Sildenafil B. Amlodipine C. Metformin D. Lisinopril

Answer 31

Sildenafil

Question 32

All of the following medications can be useful for managing stable angina in a patient with coronary artery disease except: A. Amlodipine. B. Atenolol. C. Immediate-release nifedipine. D. Isosorbide dinitrate.

Answer 32

Correct answer = C. The short-acting dihydropyridine calcium channel blocker nifedipine should be avoided in CAD patients as this can worsen angina; however, the extended-release formulation can be used.

Question 33

A 62-year-old patient with a history of asthma and vasospastic angina states that he gets chest pain both with exertion and at rest, about ten times per week. One sublingual nitroglycerin tablet always relieves his symptoms, but this medication gives him an awful headache every time he takes it. Which is the best option for improving his angina? A. Change to sublingual nitroglycerin spray. B. Add amlodipine. C. Add propranolol. D. Replace nitroglycerin with ranolazine.

Answer 33

Correct answer = B. Calcium channel blockers are preferred for vasospastic angina. ß-Blockers can actually worsen vasospastic angina; furthermore, nonselective f-blockers should be avoided in patients with asthma. The nitroglycerin spray would also be expected to cause headache, so this is not the best choice. Ranolazine is not indicated for immediate relief of an angina attack, nor is it a first-line option.

Question 34

Which side effect is associated with amlodipine? A. Bradycardia. B. Cough. C. Edema. D. QT prolongation.

Answer 34

Correct answer = C. Edema is the correct answer. The other answers are incorrect.

Question 35

A 65-year-old male experiences uncontrolled angina attacks that limit his ability to do household chores. He is adherent to a maximized dose of f-blocker with a low heart rate and low blood pressure. He was unable to tolerate an increase in isosorbide mononitrate due to headache. Which is the most appropriate addition to his antianginal therapy? A. Amlodipine. B. Aspirin. C. Ranolazine. D. Verapamil.

Answer 35

Correct answer = C. Ranolazine is the best answer. The patient's blood pressure is low, so verapamil and amlodip-ine may drop blood pressure further. Verapamil may also decrease heart rate. Ranolazine can be used when other agents are maximized, especially when blood pressure is well controlled. The patient will need a baseline ECG and lab work to ensure safe use of this medication.

Question 36

A 68-year-old male with a history of angina had a MI last month, and an echocardiogram reveals heart failure with reduced ejection fraction. He was continued on his previous home medications (diltiazem, enalapril, and nitroglycerin), and atenolol was added at discharge. He has only had a few sporadic episodes of stable angina that are relieved with nitroglycerin or rest. What are eventual goals for optimizing this medication regimen? A. Add isosorbide mononitrate. B. Increase atenolol. C. Stop atenolol and increase diltiazem. D. Stop diltiazem and change atenolol to bisoprolol.

Answer 36

Correct answer = D. Nondihydropyridine calcium channel blockers such as diltiazem should be avoided in patients with heart failure with reduced ejection fraction. Patients should be treated with one of three ß-blockers approved for heart failure with reduced ejection fraction (bisopro-lol, metoprolol succinate, or carvedilol). It sounds like his angina symptoms are well managed with his current therapy so adding isosorbide mononitrate would not be neces-sary. These symptoms may become even less frequent as his new f-blocker is titrated.