Practice Question Set #1

Antianginal drug administered by inhalation:
1. isosorbide dinitrate (Isordil, Sorbitrate)
2. amyl nitrite
3. glyeryl trinitrate
A patient with a history of both angina and esophageal spasms is told by his physician that upon recurrence of pain, take a nitroglycerin tablet, sublingually and note what happens. When pain recurs, the patient takes the "nitro" and the pain goes away in about a minute. Reasonable analysis would suggest:
1. that the pain was due to myocardial oxygen insufficiency, relieved by the action of nitroglycerin on cardiac preload
2. that the pain is more likely due to esophageal spasm, because if it were due to the heart, relief would have taken longer.
3. the test is inconclusive, since nitrates relax almost all smooth muscle--terminating anginal symptoms or symptoms of esophageal spasm
Symptoms associated with nitrates:
1. bradycardia
2. hypotension
3. headache
4. B & C
Prinzmetal (variant) angina presents in a 25 year old female. Pharmacological management could include:
1. diltiazem (Cardiazem)
2. verapamil (Isoptin, Calan)
3. propranolol (Inderal)
4. A & B
Calcium channel blocker(s) most likely to affect myocardial contractility and AV conduction:
1. nifedipine (Procardia, Adalat)
2. nicardipine (Cardene)
3. diltiazem (Cardiazem)
70 year old male with confirmed multi-vessel coronary vascular disease also suffers from COAD [chronic obstructive airway disease] and exertional angina. He is prescribed nifedipine for his angina, but shortly after beginning the medication complains of increased angina incidence. Choose an explanation:
1. Nifedipine (Procardia, Adalat) should not be used for angina.
2. Nifedipine (Procardia, Adalat), a calcium channel blocker, causes significant vasodilation. Hypotension and reflex cardiac stimulation result in increased anginal episodes
3. Nifedipine (Procardia, Adalat) in combination with propranolol, since propranolol would block reflex tachycardia due to nifedipine's vasodilatory effects.
A 60 year old patient with multivessel coronary vascular disease has suffered several myocardial infarctions. The patient is in moderate heart failure precariously controlled with diuretics and cardiac glycosides and has exertional anginal episodes about twice a day. Consider a calcium channel blocker in management of this patient:
1. Diltiazem (Cardiazem) is an effective antianginal drug which would be appropriate in this case.
2. Diltiazem (Cardiazem) is only effective in Prinzmetal's angina-as such it would not be appropriate here
3. Diltiazem (Cardiazem) is not appropriate because of its negative inotropic properties (decrease myocardial contractility) which would worsen left ventricular failure
4. Diltiazem (Cardiazem) in combination with propranolol (Inderal) would work since reflex tachycardia would be blocked
Calcium and sodium channel blocker useful in treating chronic, stable angina not responsive to typical antianginal drugs:
1. diltiazem (Cardiazem)
2. bepridil (Vascor)
3. nifedipine (Procardia, Adalat)
4. lisinopril (Prinvivil, Zestril)