Ostrum Day II Lecture

Question 1

A patient develops exertion angina about once a day. Best nitrate therapy?

Answer 1

sublingual nitroglycerin (use when needed) or spray because you don’t want long term or IV

Question 2

Biggest problem with nitrates?

Answer 2

tolerance (long-term stimulation) and headaches (sublingual preferred)

Question 3

A patient is using 20-30 sublingual nitroglycerin tablets daily. Best nitrate therapy?

Answer 3

long-acting oral or transdermal nitrate (start considering around 10x a day)

Question 4

A patient is admitted with unstable angina and is hospitalized on a telemetry bed. Best nitrate therapy?

Answer 4

transdermal, nitroglycerin paste has the advantage of quick adjustment and is very quick acting/absorption (can rapidly withdraw IV alone)

Question 5

A patient is hospitalized with unstable angina and is transferred to the CCU for recurrent chest pain. Best nitrate therapy?

Answer 5

IV nitroglycerin (goes everywhere is not that selective- can cause coronary steal)

Question 6

T or F. The administration of a BB will increase diastole and thereby increase coronary perfusion

Answer 6

T. Perfusion arteries get squeezed and shut during systole

Question 7

Can verapamil and diltiazem be given in patients with ventricular dysfunction?

Answer 7

No

Question 8

What CV reflex change would you expect with nifedipine?

Answer 8

Increased cardiac contractility

Question 9

Which drug would you never apply to patients with second-degree or greater heart block or administer with other drugs that produce heart block?

Answer 9

Verapamil

Question 10

The best choice of oral anti-HTN therapy in a patient with a history of Prinzmetal angina would be what?

Answer 10

these have normal angiograms usually (no fixed blockages)

non-dihydropyridine-type Ca2+ channel blocker

Question 11

The most effective anginal treatments are ones that do what?

Answer 11

decrease heart work and thus decrease myocardial demand (so dihydropyridines aren’t going to be the best since you’ll see a reflexive tachycardia)

Question 12

The worst choice of oral anti-HTN therapy in a patient with a history of Prinzmetal angina would be what?

Answer 12

thiazide diuretic wouldn’t do much or BB

Question 13

Nitroglycerin is most often given sublingually (as opposed to orally) to accomplish what?

Answer 13

avoid hepatic first pass and avoid tolerance by using it only when symptoms arise