Question 1

Situations that suggest referral to a specialist is appropriate include:

Accepted Answer

All three situations listed suggest a need for referral to a specialist. Unpredictable angina can indicate a worsening of the condition and may require more advanced management. New-onset angina in a post-MI patient can indicate the development of new coronary lesions that need to be evaluated and treated. When standard therapy is not successful, specialized testing and intervention may be necessary to improve symptoms and reduce risk. Therefore, all of these situations indicate the need for referral to a specialist.

Question 2

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

Accepted Answer

Combining a long-acting nitrate and a beta blocker have additive effects that allow for lower doses of both drugs to be used. This minimizes the risk of adverse reactions and side effects while providing effective treatment for angina.

Question 3

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

Accepted Answer

C

Question 4

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

Accepted Answer

Nitrate tolerance can develop with continuous exposure to nitrates, so a nitrate-free interval is recommended to prevent this. Administering isosorbide dinitrate at 7 a.m. and 2 p.m. allows for a nitrate-free period overnight.

Question 5

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

Accepted Answer

Aspirin has been shown to reduce mortality in patients with angina by preventing blood clots and reducing the risk of heart attack and stroke. Nitroglycerin is used to treat acute episodes of chest pain, but it does not provide long-term mortality benefit. ACE inhibitors or angiotensin receptor blockers may be indicated in certain cases, but not all patients with angina require them. Digoxin is not indicated for the treatment of angina.

Question 6

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.

Accepted Answer

The answer of Management of all types and grades of...

Question 7

Rapid-acting nitrates are important for all angina patients. Which of the following are true statements about their use?

Accepted Answer

The answer of Rapid-acting nitrates are important for all angina...

Question 8

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

Accepted Answer

Nitrates are beneficial for patients with angina because they help to dilate blood vessels, improving blood flow to the heart muscle. This mechanism of action can also be beneficial in conditions like heart failure and hypertension by reducing the workload on the heart and lowering blood pressure, respectively. Therefore, patients with angina who also have heart failure or hypertension can benefit from the use of nitrates.

Question 9

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

Accepted Answer

Generic formulations may be cheaper and can be bioequivalent, so cost should not be the only factor when choosing antianginal drugs. A, B, and D are all valid reasons to consider the cost of antianginal drug therapy.

Question 10

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

Accepted Answer

Beta blockers can help control arrhythmias in addition to reducing the frequency and severity of angina episodes. Hypothyroidism, hyperlipidemia, and atherosclerosis may also be present in patients with exertional angina, but beta blockers are not specifically indicated for those conditions.

Question 11

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

Accepted Answer

All three options - pulmonary embolism, pneumonia, and gastroesophageal reflux can cause noncardiac chest pain.

Question 12

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

Accepted Answer

The answer of Angina is produced by an imbalance between...

Question 13

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

Accepted Answer

Class III angina indicates a more severe form of angina, which indicates a greater risk for coronary heart disease. The other options do not necessarily indicate a high risk for significant coronary heart disease.

Question 14

Ranolazine is used in angina patients to:

Accepted Answer

Ranolazine restricts late sodium flow in the myocytes, which reduces the oxygen demand and increases the functional capacity of the heart. This leads to improved symptoms and exercise tolerance in angina patients. It does not dilate plaque-filled arteries, inhibit platelet aggregation, or induce vasoconstriction in the periphery to open coronary vessels.

Question 15

The most common cause of angina is:

Accepted Answer

Atherosclerosis, or the build-up of plaque in the coronary arteries, is the most common cause of angina. This plaque narrows the arteries and reduces blood flow to the heart muscle, causing chest pain or discomfort. Vasospasm, platelet aggregation, and low systemic oxygen can also contribute to angina, but they are not the primary cause.

Question 16

Medications are typically started for angina patients when:

Accepted Answer

Medications are typically started for angina patients when the start of class I or II symptoms occur. Class I symptoms are characterized by ordinary physical activity not causing angina whereas class II symptoms are characterized by slight limitation of ordinary activity due to angina.

Question 17

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

Accepted Answer

Drug choices to treat angina in older adults differ from those of younger adults only in consideration of risk factors for diseases associated with and increased in aging. This is because older adults are more likely to have comorbidities and other health conditions that can increase the risk of adverse effects from certain drugs. Therefore, it is important to consider these factors when choosing a drug regimen for older adults with angina.

Question 18

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

Accepted Answer

Estrogen replacement therapy has been associated with an increased risk for myocardial infarction in women, according to research studies. The other options listed have not been consistently associated with increased risk for myocardial infarction in women.

Question 19

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 or on walking or climbing stair after meals is class:

Accepted Answer

According to the grading criteria, class II angina is defined as angina that occurs on walking or climbing stairs after meals or with unusually strenuous activity.

Question 20

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

Accepted Answer

Calcium blockers are used in the management of angina primarily because they help with rate control, reducing the heart's oxygen demand by lowering the heart rate and decreasing the contractility. This alleviates the symptoms of angina by improving the balance between the oxygen supply and demand in the heart muscle.

Quiz 28: Chronic Stable Angina and Low-Risk Unstable Angina