Question 1

How are verapamil and diltiazem different from other calcium channel blockers?

Accepted Answer

In addition to arteriolar dilation, two of the calcium channel blockers, verapamil and diltiazem, also block the influx of calcium ions in cardiac muscle and in the SA and AV nodes. The remaining calcium channel blockers (chemically classified as dihydropyridines) are arterial dilators with very little direct actions on the heart.

Question 2

Identify a true statement about variant or Prinzmetal angina.

Accepted Answer

Prinzmetal angina is unpredictable and can occur at any time, even during sleep. Exertional angina is brought about by exercise, overexertion, or stress.

Question 3

David is diagnosed with unstable angina.What is the preferred therapy for this form of angina?

Accepted Answer

Unstable angina requires aggressive therapy with antianginal, anticoagulant, and antiplatelet drugs in order to prevent blood clot formation.

Question 4

Malia,a 45-year-old architect,is prone to angina attacks.Which of the following forms of nitroglycerin should Malia use to prevent angina attacks?

Accepted Answer

Nitroglycerin extended-release capsules are used daily to prevent the occurrence of anginal attacks.

Question 5

Which of the following is an important therapeutic effect achieved by nitrates in the treatment of angina?

Accepted Answer

The main effects produced by vasodilation brought about by nitrates are a decrease in venous return to the heart (decrease in preload) and a decrease in blood pressure (decrease in afterload). Consequently, cardiac work is reduced. Decrease in cardiac work reduces the amount of oxygen that is required by the heart, and this helps relieve anginal pain.

Question 6

Which of the following is true of diltiazem?

Accepted Answer

The vasodilating and cardiac effects of diltiazem are similar to those of verapamil. However, diltiazem is considered to have slightly less cardiac depressant effects but greater vasodilating actions than verapamil.

Question 7

Which of the following explains the inability of the nitrates to act as coronary dilators during angina?

Accepted Answer

Ischemia itself is a potent vasodilator so that during attacks of angina the coronary arteries are already maximally dilated. The main effect of the nitrates is to produce a general vasodilation of systemic veins and arteries.

Question 8

Betty,an angina patient,is asthmatic.Betty's doctor prescribes a combination of a nitrate and a beta-blocker to treat her angina.Which of the following combination of drugs is contraindicated?

Accepted Answer

Nonselective beta-blockers such as propranolol and nadolol should not be given to individuals with asthma. Blockade of beta-2 receptors in the respiratory tract can cause bronchoconstriction.

Question 9

What is the primary mechanism of action of both nitrate drugs and drugs used to treat erectile dysfunction?

Accepted Answer

The primary mechanism of action of both nitrate drugs and drugs used to treat erectile dysfunction is to increase the formation of nitric oxide.

Question 10

What causes exertional angina?

Accepted Answer

The most common type of angina is caused by exercise, overexertion, or stress. This type is classified as exertional angina and its occurrence is usually predictable. It is caused by insufficient coronary blood flow due to atherosclerotic plaques.

Question 11

Which of the following is true of nitroglycerin ointment?

Accepted Answer

Nitroglycerin ointment is used prophylactically to prevent the occurrence of angina. The ointment is applied topically to an area of the chest or abdomen and is covered with a plastic dressing. Absorption occurs through the skin, with an onset of action of 30 minutes and a duration of 4 to 8 hours, depending on the amount applied.

Question 12

Unlike nondihydropyridines,dihydropyridines:

Accepted Answer

In addition to arteriolar dilation, two of the calcium channel blockers (nondihydropyridines), verapamil and diltiazem, also block the influx of calcium ions in cardiac muscle and in the SA and AV nodes. The remaining calcium channel blockers (chemically classified as dihydropyridines) are arterial dilators with very little direct actions on the heart.

Question 13

Vincent,a 35-year-old man,is prescribed Nitrogard,to prevent anginal attacks.Which of the following drugs is contraindicated in this scenario?

Accepted Answer

An important drug interaction may occur with nitrate drugs and drugs such as sildenafil (Viagra) used to treat erectile dysfunction (ED). The ED drugs can potentiate the effects of the nitrates and cause excessive vasodilation, hypotension, reflex tachycardia, and potentially myocardial infarction. Consequently, these two drug classes should not be administered at the same time.

Question 14

While Kendall is taking a stroll in a park near his house,his chest starts hurting.Assuming that Kendall is carrying the appropriate medication for his condition,which of the following routes of administration is he most likely to use?

Accepted Answer

Assuming that Kendall is carrying the appropriate medication for his condition, most likely a nitrate, he is very likely to administer this medication through the sublingual route. The nitrates are administered during attacks of angina to relieve the intense pain. The most common route of administration is sublingual.

Question 15

Will,a 38-year-old man,is prone to anginal attacks.Will's doctor prescribes a combination of drugs for long-term as well as short-term management of angina.Which of the following is the most likely combination of drugs prescribed by Will's doctor?

Accepted Answer

Beta-blockers can be used in combination with nitrates in patients who require more than one drug to control angina. When used in combination with nitrates, blockade of beta-1 receptors will usually prevent the reflex tachycardia that may occur with the nitrates. In this scenario, the most likely combination of drugs used is nadolol (a beta-blocker) and isosorbide dinitrate (a nitrate).

Quiz 24: Diuretics