Lippincott Chapter 21: Antianginal Drugs Flashcards
21.1 What is the clinical term for angina caused by coronary
vasospasm?
A. Classic angina.
B. Myocardial infarction.
C. Prinzmetal angina.
D. Unstable angina
Correct answer = C. Prinzmetal angina is angina caused
by vasospasm of the coronary arteries. It is also known
as vasospastic or variant angina. The other answers
refer to angina (with varying levels of severity) caused by
atherosclerosis.
21.2 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.
Correct answer = C. The short-acting dihydropyridine cal-
cium channel blocker nifedipine should be avoided in CAD
patients as this can worsen angina; however, the extended-
release formulation can be used.
21.3 A 72-year-old male presents to the primary care
clinic complaining of chest tightness and pressure
that is increasing in severity and frequency. His
current medications include atenolol, lisinopril, and
nitroglycerin. Which intervention is most appropriate at
this time?
A. Add amlodipine.
B. Initiate isosorbide mononitrate.
C. Initiate ranolazine.
D. Refer the patient to the nearest emergency room
for evaluation
Correct answer = D. Crescendo angina is indicative of
unstable angina that requires further workup.
21.4 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.
Correct answer = B. Calcium channel blockers are preferred
for vasospastic angina. β-Blockers can actually worsen
vasospastic angina; furthermore, nonselective β-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 immedi-
ate relief of an angina attack, nor is it a first-line option.
21.5 Which side effect is associated with amlodipine?
A. Bradycardia.
B. Cough.
C. Edema.
D. QT prolongation.
Correct answer = C. Edema is the correct answer. The other
answers are incorrect
21.6 Which medication should be prescribed to all anginal
patients to treat an acute attack?
A. Isosorbide dinitrate.
B. Nitroglycerin patch.
C. Nitroglycerin sublingual tablet or spray.
D. Ranolazine
Correct answer = C. The other options will not provide
prompt relief of angina and should not be used to treat an
acute attack.
21.7 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 addition to his
antianginal therapy?
A. Amlodipine.
B. Aspirin.
C. Ranolazine.
D. Verapamil.
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.
21.8 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.
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 β-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 ther-
apy so adding isosorbide mononitrate would not be neces-
sary. These symptoms may become even less frequent as
his new β-blocker is titrated
21.9 Which of the following medications would be safe to
use in a patient taking ranolazine?
A. Carbamazepine.
B. Clarithromycin.
C. Enalapril.
D. Quetiapine.
Correct answer = C. All other medications should be avoided
due to potential drug–drug interactions.
21.10 A patient whose angina was previously well controlled
with once-daily isosorbide mononitrate states that
recently he has been taking isosorbide mononitrate
twice a day to control angina symptoms that are
occurring more frequently during early morning
hours. Which of the following is the best option for this
patient?
A. Continue once-daily administration of isosorbide
mononitrate but advise the patient to take this
medication in the evening.
B. Advise continuation of isosorbide mononitrate
twice daily for full 24-hour coverage of anginal
symptoms.
C. Switch to isosorbide dinitrate, as this has a longer
duration of action than the mononitrate.
D. Switch to nitroglycerin patch for consistent drug
delivery and advise him to wear the patch around
the clock.
Correct answer = A. It is important to maintain a nitrate-free
period to prevent the development of tolerance to nitrate
therapy. The mononitrate formulation has the longer half-
life. The nitroglycerin patch should be taken off for 10 to 12
hours daily to allow for nitrate-free interval.
