Deck 29: Angina

Question 1

Situations that suggest referral to a specialist is appropriate include:

A)When chronic stable angina becomes unpredictable in its characteristics and precipitating factors
B)When a post-MI patient develops new-onset angina
C)When standard therapy is not successful in improving exercise tolerance or reducing the incidence of angina
D)All of the above

Answer 1

All of the above

Question 2

Which of the following drugs has been associated with increased risk for MI in women?

A)ASA
B)Beta blockers
C)Estrogen replacement
D)Lipid-lowering agents

Answer 2

Estrogen replacement

Question 3

Ranolazine is used in angina patients to:

A)Dilate plaque-filled arteries
B)Inhibit platelet aggregation
C)Restrict late sodium flow in the myocytes
D)Induce vasoconstriction in the periphery to open coronary vessels

Answer 3

Restrict late sodium flow in the myocytes

Question 4

Patients who have angina, regardless of class, who are also diabetic, should be on:

A)Nitrates
B)Beta blockers
C)ACE inhibitors
D)Calcium channel blockers

Question 5

The most common cause of angina is:

A)Vasospasm of the coronary arteries
B)Atherosclerosis
C)Platelet aggregation
D)Low systemic oxygen

Question 6

The New York Heart Association and the Canadian Cardiovascular Society have described grading criteria for levels of angina. Angina that occurs with unusually strenuous activity is class:

A)I
B)II
C)III
D)IV

Question 7

Drug choices to treat angina in older adults differ from those in younger adults only in:

A)Consideration of risk factors for diseases associated with older adults
B)The placement of drug therapy as a treatment choice before lifestyle changes are tried
C)The need for at least three drugs in the treatment regimen because of the complexity of angina in the older adult
D)Those with higher risk for silent myocardial infarction (MI)

Question 8

The rationale for prescribing calcium blockers for angina can be based on the need for:

A)Increased inotropic effect in the heart
B)Increasing peripheral perfusion
C)Keeping heart rate high enough to ensure perfusion of coronary arteries
D)Help with rate control

Question 9

Nitrates are especially helpful for patients with angina who also have:

A)Heart failure
B)Hypertension
C)Both 1 and 2
D)Neither 1 nor 2

Question 10

Angina is produced by an imbalance between myocardial oxygen supply (MOS) and myocardial oxygen demand (MOD) in the myocardium. Which of the following drugs help to correct this imbalance by increasing MOS?

A)Calcium channel blockers
B)Beta blockers
C)Angiotensin-converting-enzyme (ACE) inhibitors
D)Aspirin (ASA)

Question 11

To reduce mortality, all patients with angina, regardless of class, should be on:

A)ASA 81 to 325 mg/day
B)Nitroglycerin sublingually for chest pain
C)ACE inhibitors or angiotensin receptor blockers
D)Digoxin

Question 12

Beta blockers are especially helpful for patients with exertional angina who also have:

A)Arrhythmias
B)Hypothyroidism
C)Hyperlipidemia
D)Atherosclerosis

Question 13

Management of all types and grades of angina includes the use of lifestyle modification to reduce risk factors. Which of these modifications are appropriate for which reason? Both the modification and the reason for it must be true for the answer to be correct.

A)Lose at least 10 pounds of body weight. Excessive weight increases cardiac workload.
B)Reduce sodium intake to no more than 2,400 mg of sodium per day. Sodium increases blood volume and cardiac workload.
C)Increase potassium intake to at least 100 mEq/day. High levels of potassium improve the heart's contractility and oxygen supply.
D)Intake only a moderate amount of alcohol. Research shows that too much alcohol is detrimental to cardiac function.

Question 14

Not all chest pain is caused by myocardial ischemia. Noncardiac causes of chest pain include:

A)Pulmonary embolism
B)Pneumonia
C)Gastroesophageal reflux
D)All of the above

Question 15

Isosorbide dinitrate is a long-acting nitrate given twice daily. The schedule for administration is 7 a.m. and 2 p.m. because:

A)Long-acting forms have a higher risk for toxicity.
B)Orthostatic hypotension is a common adverse effect.
C)It must be taken with milk or food.
D)Nitrate tolerance can develop.

Question 16

Cost of antianginal drug therapy should be considered in drug selection because of all of the following EXCEPT:

A)Patients often require multiple drugs.
B)A large number of angina patients are older adults on fixed incomes.
C)Generic formulations may be cheaper but are rarely bioequivalent.
D)Lack of drug selectivity may result in increased adverse reactions.

Question 17

Patients at high risk for developing significant coronary heart disease are those with:

A)Low-density lipoproteins (LDL) values between 100 and 130
B)Systolic blood pressure between 120 and 130
C)Class III angina
D)Obesity

Question 18

Medications are typically started for angina patients when:

A)The first permanent electrocardiographic (ECG) changes occur
B)Class I or II symptoms begin
C)The events trigger a trip to the emergency department
D)Troponin levels become altered

Question 19

When is ASA used in angina patients?

A)All angina patients should be taking ASA unless it is contraindicated for allergy or other medical reasons.
B)ASA should only be used in men.
C)ASA has no role in angina, but is useful in MI prevention.
D)ASA is best used at the time of an angina attack.

Question 20

Combinations of a long-acting nitrate and a beta blocker are especially effective in treating angina because:

A)Nitrates increase MOS and beta blockers increase MOD.
B)Their additive effects permit lower doses of both drugs and their adverse reactions cancel each other out.
C)They address the pathology of patients with exertional angina who have fixed atherosclerotic coronary heart disease.
D)All of the above

Question 21

Angina can cause changes in ECG patterns. Which of the following is true?

A)Vasospastic angina typically shows an ischemic pattern.
B)Occlusive angina normally does not have ECG changes.
C)Mild classic angina is associated with an injury ECG pattern.
D)Vasospastic angina is linked with elevated ST segments.

Question 22

Which formulation of nitrate may be most cost effective for the patient who rarely has the need for dosing?

A)Oral
B)Sublingual tablets
C)Sublingual spray
D)Transdermal patches

Question 23

As patients with hyperlipidemia and angina age, they may find their nitro glycerin tablets "do not work as well." This is a function of:

A)Faulty memory
B)Forgetting how to use the drugs
C)Blunted coronary artery dilation due to calcified plaques
D)Myocardial atrophy of aging

Question 24

Your patient reports he could walk up two flights of stairs last year without pain. Earlier this year this fell to one flight of stairs without pain. He is concerned because now he can only go six steps without pain. What is this called?

A)Prinzmetal angina
B)Variant angina
C)Crescendo angina
D)Classic angina

Question 25

Vasospastic angina is linked with:

A)Alcoholic hearts
B)Higher cholesterol levels
C)Recreational drugs such as cocaine
D)Older age