Quiz on angina pectoris

A 70-year-old male with a history of stable angina is on a regimen of aspirin, a beta-blocker, and a statin. He reports persistent exertional angina that limits his daily activities. He is not a candidate for revascularization. His physician is considering adding a new antianginal medication. Which of the following mechanisms of action is MOST consistent with the therapeutic goal of reducing myocardial oxygen demand by delaying depolarization and reducing intracellular sodium overload? *

A 65-year-old male presents to the emergency department with a sudden onset of substernal chest pressure radiating to his left arm, accompanied by diaphoresis and shortness of breath. He rates the pain as 8/10. His blood pressure is 150/90 mmHg, heart rate is 95 bpm, and oxygen saturation is 96% on room air. An electrocardiogram (ECG) shows ST-segment depression in leads V4-V6. He has a history of hypertension and hyperlipidemia. Which of the following is the MOST appropriate initial pharmacological management for this patient? *

A 72-year-old male with a history of hypertension and stable angina presents with new-onset angina that is occurring at rest and lasting for 20 minutes. His ECG shows transient ST-segment elevation. He is currently taking aspirin, atorvastatin, and metoprolol. Which of the following is the MOST appropriate immediate management for this patient? *

A 60-year-old male with stable angina is being treated with a beta-blocker and aspirin. He experiences exertional angina despite this regimen. His physician is considering adding a calcium channel blocker. Which of the following calcium channel blockers is generally considered the MOST appropriate for patients with angina, particularly those with concomitant hypertension, due to its long duration of action and vasodilatory effects? *

A 70-year-old male with exertional angina is experiencing frequent episodes despite optimal medical therapy including beta-blockers, statins, and aspirin. He has undergone cardiac catheterization which revealed significant coronary artery disease but is deemed a poor candidate for revascularization due to comorbidities. His physician is considering adding a medication to further reduce his angina frequency. Which of the following medications works primarily by decreasing myocardial oxygen demand through peripheral vasodilation and a reduction in preload and afterload? *

A 58-year-old woman with a history of stable angina is prescribed isosorbide mononitrate 30 mg twice daily for symptom relief. She reports that her angina episodes have decreased in frequency but still occur during strenuous exercise. She is concerned about potential interactions with her current medications: lisinopril 10 mg once daily and atorvastatin 20 mg once daily. Which of the following is the MOST likely significant drug interaction to monitor for with isosorbide mononitrate? *

A 65-year-old male with exertional angina has been managed with sublingual nitroglycerin as needed. He now reports experiencing angina at rest, with episodes lasting 5-10 minutes and occurring 2-3 times per night. His vital signs are stable. An ECG shows T-wave inversions in the anterior leads. He is currently taking aspirin and atorvastatin. Which of the following is the MOST appropriate next step in management? *

A 50-year-old male with stable angina is on maximal medical therapy including a beta-blocker, aspirin, and a statin. He continues to have exertional angina. He is not a candidate for revascularization. His physician is considering adding a medication that works by improving myocardial efficiency by shifting energy production from fatty acid oxidation to glucose oxidation. Which of the following medications has this mechanism of action? *

A 62-year-old female presents with exertional chest pain that is relieved by rest. She has a history of hypertension and diabetes mellitus. Her current medications include metformin 500 mg twice daily, lisinopril 20 mg once daily, and atorvastatin 40 mg once daily. Her lipid panel shows LDL 90 mg/dL and HDL 45 mg/dL. She is prescribed sublingual nitroglycerin 0.4 mg as needed for angina. She reports using it 3-4 times per week. Her physician is considering adding a long-acting nitrate. Which of the following is a crucial counseling point regarding the use of long-acting nitrates for angina prophylaxis? *

A 55-year-old male with a history of stable angina is on maximal medical therapy, including a beta-blocker, a long-acting nitrate, and aspirin. He continues to experience angina episodes twice a week despite these medications. His ejection fraction is 55%. He is not a candidate for revascularization. Which of the following medications is indicated for further reduction of angina symptoms in this patient? *

A 68-year-old female with exertional angina is prescribed a beta-blocker. She has a history of asthma and is currently experiencing a mild exacerbation. Which of the following beta-blockers would be the MOST appropriate choice for her, given its cardioselectivity? *

A 75-year-old male with a history of coronary artery disease and stable angina is admitted for an elective percutaneous coronary intervention (PCI). He is currently on aspirin, clopidogrel, a beta-blocker, and a high-intensity statin. Post-PCI, he develops recurrent chest pain despite adequate stent placement. His ECG shows new T-wave inversions. Which of the following is the MOST appropriate next step in management? *