51 Questions
Which CYP 3A4 inhibitor is classified as a papaverine derivative with higher affinity for the heart?
Verapamil (Calan)
What adverse effect is associated with non-dihydropyridine (Non-DHP) calcium channel blockers?
Constipation and gingival hyperplasia
Which medication is a late sodium current blocker and exerts antianginal and anti-ischemic effects without changing hemodynamic parameters?
Ranolazine (Ranexa)
Which calcium channel blocker has the highest affinity for the heart?
Verapamil
What is the most common cause of stable angina?
Atherosclerosis
How is stable angina diagnosed?
ECG during exercise
Which medication decreases the oxygen demands of the heart by slowing the heart rate and reducing the force of the heart muscle contraction?
Beta blockers
What is a characteristic feature of unstable angina on ECG?
T-wave inversion
What is the recommended treatment for unstable angina?
Platelet inhibitor
What is the mechanism of action of nitrates in stable angina?
Vasodilation of coronary vessels
Which condition is more likely to lead to a myocardial infarction?
Unstable angina
Which medication has not been proven to decrease the risk for heart attack and death in unstable angina?
Verapamil
What is the prime determinant of Silent Ischemia?
Oxygen demand
What is the main goal of antianginal drug treatment?
Reduce the frequency and intensity of anginal attacks
What is the pathophysiological cause of Angina Pectoris?
Inadequate blood supply to the heart
What is the classification basis for Acute Coronary Syndrome?
Symptom severity
What is the primary treatment for ALL types of Ischemic Heart Disease?
Lifestyle modifications
What is the main determinant of Ischemic Heart Disease?
Oxygen supply and demand imbalance
What is the characteristic symptom of Angina Pectoris?
Severe pain, squeezing, or tightness in the chest
What is the duration of an Angina attack?
Can last from 15s to 15min
What is the mechanism of action of ranolazine (Ranexa)?
Prevents late inward sodium (late INa channel) entry into cells
Which adverse effect is associated with non-dihydropyridine (Non-DHP) calcium channel blockers?
Constipation and gingival hyperplasia
What is the prime determinant of Silent Ischemia?
Lack of typical anginal pain
Which medication is contraindicated in Atrioventricular Block (AV Block) due to its effect on heart rate through the AV node?
Verapamil
What is the most common cause of stable angina?
Coronary artery stenosis greater than 70%
What is the mechanism of action of nitrates in stable angina?
Vasodilator effect on peripheral veins and arteries
What is the characteristic feature of unstable angina on ECG?
ST depression (Not elevation) and/or T-wave inversion
What is the recommended treatment for unstable angina?
Nitrates, Beta-blockers, Statins, Anticoagulants or platelet inhibitors
What is the prime determinant of Silent Ischemia?
Absence of chest pain during ischemia
Which medication has not been proven to decrease the risk for heart attack and death in unstable angina?
Verapamil
What is the main goal of antianginal drug treatment?
To reduce myocardial oxygen demand and increase oxygen supply to the heart
What is the classification basis for Acute Coronary Syndrome?
Presence of unstable angina, NSTEMI, or STEMI
What is the main goal of antianginal drug treatment?
Decrease the overall progression of coronary artery disease (CAD)
What is the prime determinant of Silent Ischemia?
Episodes of ischemia that do not cause angina
What is the classification basis for Acute Coronary Syndrome?
Constellation of clinical signs or symptoms suggestive of MI, STEMI, NSTEMI, Angina
What is the characteristic symptom of Angina Pectoris?
Severe pain, squeezing, or tightness in the chest
Which medication decreases the oxygen demands of the heart by slowing the heart rate and reducing the force of the heart muscle contraction?
Beta-blockers
What is the duration of an Angina attack?
15 seconds to 15 minutes
What is the most common cause of stable angina?
Coronary atherosclerotic plaque formation
What is the pathophysiological cause of Angina Pectoris?
Inadequate blood supply to the heart
Which medication used for the treatment of angina is contraindicated with phosphodiesterase-5 (PDE-5) inhibitors due to the risk of extreme hypotension and death?
Isosorbide Mononitrate
Which medication is the drug of choice for prompt relief and prophylaxis of stable or vasospastic angina?
Nitroglycerin sublingual (NTG SL)
Which calcium channel blocker has a higher affinity for the peripheral vessels and can cause gingival hyperplasia and hypotension?
Nifedipine
Which medication, when used in patients with asthma, requires caution due to its potential to worsen the condition?
Metoprolol
Which medication should not be used in heart failure patients due to the risk of exacerbating edema?
Verapamil
Which medication must be discontinued gradually over 5-10 days to avoid rebound angina or hypertension?
Metoprolol
Which medication causes the formation of Nitric oxide (NO) leading to activation of guanylate cyclase, increasing cGMP, and relaxation via dephosphorylation of myosin light chains?
Nitroglycerin sublingual (NTG SL)
Which calcium channel blocker has a higher affinity for the heart and can cause negative inotropy due to slowing of SA and AV node conduction?
Verapamil
Which medication, due to its mechanism of action, is not used for vasospastic angina and may worsen such attacks by blocking some β2 receptors that produce vasodilator effects?
Metoprolol
Which medication, due to its mechanism of action, is contraindicated in brittle diabetics and heart block patients?
Metoprolol
Which medication, when used in patients with a history of syncope and age ≥ 65, requires caution due to its potential to exacerbate episodes of syncope?
Isosorbide Mononitrate
Study Notes
CYP 3A4 Inhibitor
- Dronedarone is a papaverine derivative with higher affinity for the heart
Calcium Channel Blockers
- Non-dihydropyridine (Non-DHP) calcium channel blockers are associated with bradycardia
- Verapamil has the highest affinity for the heart
Angina
- Stable angina is most commonly caused by atherosclerosis
- Diagnosis of stable angina is through electrocardiogram (ECG) and exercise tolerance test
- Ivabradine decreases the oxygen demands of the heart by slowing the heart rate and reducing the force of the heart muscle contraction
- Unstable angina is diagnosed by ECG with ST-segment depression or elevation
- Recommended treatment for unstable angina includes antiplatelet therapy and beta blockers
- Nitrates decrease oxygen demands of the heart by vasodilation, reducing preload and subsequently workload of the heart
Ischemic Heart Disease
- Prime determinant of Silent Ischemia is impaired glucose tolerance
- Main goal of antianginal drug treatment is to reduce frequency and severity of angina attacks
- Pathophysiological cause of Angina Pectoris is imbalance between oxygen supply and demand
- Classification basis for Acute Coronary Syndrome is existence of myocardial necrosis
- Primary treatment for ALL types of Ischemic Heart Disease is antiplatelet therapy and statins
- Main determinant of Ischemic Heart Disease is coronary atherosclerosis
- Characteristic symptom of Angina Pectoris is chest pain or discomfort
- Duration of an Angina attack is usually 5-30 minutes
Medications
- Ranolazine (Ranexa) is a late sodium current blocker exerting antianginal and anti-ischemic effects
- Beta blockers are contraindicated in Atrioventricular Block (AV Block) due to its effect on heart rate through the AV node
- Organic nitrates decrease oxygen demands of the heart by vasodilation, reducing preload and subsequently workload of the heart
- Phosphodiesterase-5 (PDE-5) inhibitors are contraindicated with nitrates due to the risk of extreme hypotension and death
- Nitroglycerin is the drug of choice for prompt relief and prophylaxis of stable or vasospastic angina
- Verapamil can cause gingival hyperplasia and hypotension
- Beta blockers require caution in asthma patients due to potential to worsen the condition
- Hydralazine should not be used in heart failure patients due to the risk of exacerbating edema
- Beta blockers must be discontinued gradually over 5-10 days to avoid rebound angina or hypertension
- Nitrates cause the formation of Nitric oxide (NO) leading to activation of guanylate cyclase, increasing cGMP, and relaxation via dephosphorylation of myosin light chains
- Verapamil has a higher affinity for the heart and can cause negative inotropy due to slowing of SA and AV node conduction
- Beta blockers are not used for vasospastic angina and may worsen such attacks by blocking some β2 receptors that produce vasodilator effects
- Beta blockers are contraindicated in brittle diabetics and heart block patients due to its mechanism of action
- Ivabradine requires caution in patients with a history of syncope and age ≥ 65 due to its potential to exacerbate episodes of syncope
Test your knowledge of variant (Prinzmetal) angina with this quiz. Explore the symptoms, triggers, and diagnostic features of this form of angina, also known as vasospastic angina.
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