Question 1

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 2

The most common cause of angina is:

Accepted Answer

Atherosclerosis (build-up of plaque in the coronary arteries) is the most common cause of angina, as it restricts blood flow to the heart muscle. Vasospasm, platelet aggregation, and low systemic oxygen can also contribute to angina, but they are not the primary cause.

Question 3

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

Accepted Answer

Class III angina indicates moderate limitation of physical activity due to angina symptoms and suggests a significant level of coronary artery disease. Patients with this level of angina are at high risk for developing significant coronary heart disease.

Question 4

Medications are typically started for angina patients when:

Accepted Answer

Medications are typically started when a patient experiences class I or II angina symptoms, which are mild or moderate symptoms, respectively. Class III symptoms indicate severe angina and may require additional interventions such as revascularization. The onset of EKG changes or altered troponin levels may be used to support a diagnosis of angina, but they are not typically the sole criteria for starting medication. Emergency department visits may prompt evaluation and treatment for angina, but medications would ideally be started before symptoms become severe enough to require emergent intervention.

Question 5

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

Accepted Answer

Combinations of a long-acting nitrate and a beta blocker are especially effective in treating angina because their additive effects permit lower doses of both drugs and their adverse reactions cancel each other out.

Question 6

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 of myocardial infarction in women, particularly in older women and those with pre-existing cardiovascular disease. Aspirin, beta blockers, and lipid-lowering agents have been shown to decrease the risk of myocardial infarction in certain populations.

Question 7

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 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

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 10

Ranolazine is used in angina patients to:

Accepted Answer

Ranolazine works by inhibiting the late sodium current in myocytes, which helps to reduce the intracellular calcium overload during ischemia and decrease the tension and energy demand of the cardiac muscle. This, in turn, leads to improved myocardial perfusion and reduced angina symptoms. It does not dilate plaque-filled arteries, inhibit platelet aggregation, or induce vasoconstriction in the periphery to open coronary vessels.

Question 11

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

Angina that occurs with unusually strenuous activity or on walking or climbing stair after meals is classified as Class II angina, which is defined as angina that occurs with moderate exertion. Class I angina occurs only with prolonged or strenuous physical activity, Class III angina occurs with less than ordinary activity, and Class IV angina occurs at rest.

Question 12

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

Accepted Answer

Aspirin is a standard therapy for all patients with angina, regardless of class, to reduce the risk of mortality associated with coronary artery disease. Nitroglycerin is used for acute symptom relief and does not reduce mortality. ACE inhibitors or angiotensin receptor blockers may be added in patients with comorbidities such as hypertension or heart failure, but are not necessary for all patients with angina. Digoxin is not indicated for the treatment of angina.

Question 13

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

Accepted Answer

Beta blockers can help control arrhythmias, which can be a contributing factor to exertional angina. They do not have a significant impact on hypothyroidism, hyperlipidemia, or atherosclerosis.

Question 14

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

Accepted Answer

The statement "Generic formulations may be cheaper but are rarely bioequivalent" is untrue. Generic drugs are required by law to be bioequivalent to their brand name counterparts. Therefore, cost considerations should not be based on the assumption that generic formulations are inferior. Rather, cost should be considered based on the individual patient's financial situation and insurance coverage. A, B, and D are all valid reasons to consider the cost of antianginal drug therapy in drug selection.

Question 15

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

Accepted Answer

All of the above (pulmonary embolism, pneumonia, gastroesophageal reflux) are noncardiac causes of chest pain.

Question 16

Situations that suggest referral to a specialist is appropriate include:

Accepted Answer

All of the given situations suggest referral to a specialist. When chronic stable angina becomes unpredictable in its characteristics and precipitating factors, it may point towards the progression of the disease, indicating the need for specialist evaluation. A post-myocardial infarction patient developing new-onset angina puts them at higher risk of another heart attack, indicating the need for specialist evaluation for appropriate management. When standard therapy is not successful in improving exercise tolerance or reducing the incidence of angina, specialized care is needed for better control of symptoms and preventing complications.

Question 17

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

Accepted Answer

Treatment choices for angina in older adults may need to take into account the increased risk factors for diseases common in aging individuals, such as hypertension or diabetes. This may alter the choice and dosing of medications used to treat angina in this population.

Question 18

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

Accepted Answer

ACE inhibitors are recommended for diabetic patients with angina as they provide cardiovascular protection and help manage blood pressure and renal function.

Question 19

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 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