A patient with acute angina symptoms needs a drug that directly reduces cardiac workload by venodilation. Which drug best fits?

A) Propranolol

B) Nitroglycerin

C) Ranolazine

D) Ivabradine

B. Nitroglycerin

Which drug class is most directly used for immediate angina relief rather than mainly prophylaxis?

A) Nitrates

B) Beta blockers

C) Calcium channel blockers

D) Late sodium inhibitors

A. Nitrates

Nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate belong to which drug class?

A) Beta blockers

B) Calcium channel blockers

C) Nitrates

D) SA node inhibitors

C. Nitrates

Which name clue helps identify nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate?

A) They end in “olol”

B) They sound nitrate-related

C) They end in “dipine”

D) They contain “iva”

B. They sound nitrate-related

Nitrates release which mediator to produce vasodilation?

A) Angiotensin II

B) Dopamine

C) Acetylcholine

D) Nitric oxide

D. Nitric oxide

Nitric oxide from nitrates activates which enzyme?

A) Guanylyl cyclase

B) ACE

C) Renin

D) Vesicular transporter

A. Guanylyl cyclase

Activation of guanylyl cyclase by nitrates increases which second messenger?

A) cAMP

B) cGMP

C) IP3

D) DAG

B. cGMP

Nitrate-induced vasodilation decreases cardiac work mainly by reducing which variable?

A) Afterload only

B) Heart rate only

C) Venous return

D) Contractility only

C. Venous return

Decreased venous return from nitrates helps angina by causing which effect?

A) Increased preload

B) Decreased heart work

C) Increased oxygen demand

D) Increased contractility

B. Decreased heart work

A patient takes nitroglycerin. Which adverse effect is most likely?

A) Headache

B) Constipation

C) Bronchoconstriction

D) QT prolongation

A. Headache

A patient takes isosorbide mononitrate. Which adverse effect best explains this?

A) Hypertension

B) Bradycardia

C) Hypotension

D) Bronchoconstriction

C. Hypotension

Which adverse effect can happen with nitrates?

A) Visual brightness changes

B) Reflex tachycardia

C) QT prolongation

D) Constipation

B. Reflex tachycardia

Which nitrate is commonly used for direct angina symptom relief?

A) Atenolol

B) Amlodipine

C) Ranolazine

D) Nitroglycerin

D. Nitroglycerin

Which drug is a long-acting nitrate listed in the notes?

A) Metoprolol

B) Isosorbide mononitrate

C) Diltiazem

D) Ranolazine

B. Isosorbide mononitrate

Beta blockers help angina mainly by decreasing which cardiac functions?

A) Venous return and preload

B) Sodium current and QT interval

C) Heart rate and contractility

D) SA node current and vision

C. Heart rate and contractility

Why are beta blockers useful in angina prophylaxis?

A) They increase oxygen supply

B) They decrease oxygen demand

C) They increase venous return

D) They increase reflex tachycardia

B. They decrease oxygen demand

Which beta blocker was listed in the angina chapter notes?

A) Propranolol

B) Prazosin

C) Nitroglycerin

D) Fenoldopam

A. Propranolol

Which pair contains beta blockers used for angina prophylaxis?

A) Verapamil and diltiazem

B) Atenolol and metoprolol

C) Ranolazine and ivabradine

D) Nitroglycerin and isosorbide

B. Atenolol and metoprolol

Which suffix commonly identifies beta blockers?

A) “dipine”

B) “sartan”

C) “olol”

D) “nitrate”

C. “olol”

Which adverse effect can occur because beta blockers slow the heart?

A) Headache

B) QT prolongation

C) Bradycardia

D) Constipation

C. Bradycardia

A patient with asthma develops wheezing after starting propranolol. Which adverse effect is most likely?

A) Bronchoconstriction

B) Visual brightness

C) Hypotension only

D) QT prolongation

A. Bronchoconstriction

Bronchoconstriction is especially concerning with which type of beta blocker?

A) Beta-1 selective blockers

B) Nonselective beta blockers

C) Calcium channel blockers

D) Late sodium inhibitors

B. Nonselective beta blockers

Which beta blocker is nonselective and therefore more concerning in asthma?

A) Metoprolol

B) Atenolol

C) Propranolol

D) Ivabradine

C. Propranolol

Beta blockers are mainly used in angina in which way?

A) Direct acute relief

B) Prophylactically

C) Only for headache relief

D) Only for QT shortening

B. Prophylactically

Calcium channel blockers used for angina block which channel type?

A) Sodium channels

B) Potassium channels

C) Chloride channels

D) L-type calcium channels

D. L-type calcium channels

Which drug group contains calcium channel blockers listed in the notes?

A) Verapamil and diltiazem

B) Propranolol and atenolol

C) Nitroglycerin and isosorbide

D) Ranolazine and ivabradine

A. Verapamil and diltiazem

Which calcium channel blockers contain the “dipine” name clue?

A) Verapamil and diltiazem

B) Nifedipine and amlodipine

C) Propranolol and metoprolol

D) Nitroglycerin and isosorbide

B. Nifedipine and amlodipine

Calcium channel blockers improve angina mainly by causing which effect?

A) Increased contractility

B) Increased cardiac work

C) Decreased oxygen demand

D) Increased venous return

C. Decreased oxygen demand

Why does blocking L-type calcium channels help reduce angina symptoms prophylactically?

A) Less heart work is needed

B) More renin is released

C) More oxygen is consumed

D) More reflex tachycardia occurs

A. Less heart work is needed

Which listed drug is a calcium channel blocker?

A) Atenolol

B) Nitroglycerin

C) Diltiazem

D) Ranolazine

C. Diltiazem

Which listed drug is a dihydropyridine calcium channel blocker?

A) Nifedipine

B) Verapamil

C) Propranolol

D) Ivabradine

A. Nifedipine

Which listed drug is a non-dihydropyridine calcium channel blocker?

A) Isosorbide dinitrate

B) Verapamil

C) Metoprolol

D) Ranolazine

B. Verapamil

Calcium channel blockers in these notes are mainly used for angina in which way?

A) As direct acute nitrates

B) Prophylactically

C) Only for bronchospasm

D) Only for QT shortening

B. Prophylactically

A patient with angina is given amlodipine. Which mechanism best explains its benefit?

A) Blocks L-type calcium channels

B) Releases nitric oxide

C) Inhibits late sodium current

D) Blocks beta receptors

A. Blocks L-type calcium channels

Which antianginal drug inhibits the late sodium current in the heart?

A) Nitroglycerin

B) Metoprolol

C) Ranolazine

D) Amlodipine

C. Ranolazine

Inhibiting late sodium current with ranolazine causes which therapeutic effect?

A) Improves cardiac efficiency

B) Increases venous return

C) Increases heart rate

D) Activates guanylyl cyclase

A. Improves cardiac efficiency

Ranolazine decreases angina mainly by reducing which cardiac requirement?

A) Blood pressure only

B) Myocardial oxygen demand

C) Bronchial oxygen delivery

D) Venous oxygen content

B. Myocardial oxygen demand

Ranolazine is mainly used in angina therapy in which way?

A) Direct acute relief

B) Emergency vasodilation

C) Prophylactically

D) Reflex tachycardia induction

C. Prophylactically

Which adverse effect is associated with ranolazine?

A) Bronchoconstriction

B) Gynecomastia

C) Ototoxicity

D) QT prolongation

D. QT prolongation

A patient is on ranolazine. Which listed side effect does this match?

A) Dizziness

B) Headache

C) Cough

D) Reflex tachycardia

A. Dizziness

Which gastrointestinal side effect is associated with ranolazine?

A) Diarrhea

B) Constipation

C) Vomiting

D) Metallic taste

B. Constipation

A patient with angina needs prophylaxis without directly lowering symptoms like nitrates. Which drug inhibits late sodium current?

A) Ranolazine

B) Nitroglycerin

C) Isosorbide dinitrate

D) Propranolol

A. Ranolazine

Which antianginal drug inhibits the SA node pacemaker current?

A) Amlodipine

B) Ivabradine

C) Isosorbide mononitrate

D) Atenolol

B. Ivabradine

Ivabradine lowers myocardial oxygen demand primarily by decreasing which variable?

A) Venous return

B) Contractility

C) Heart rate

D) QT interval

C. Heart rate

Ivabradine decreases heart rate by inhibiting which cardiac target?

A) L-type calcium channels

B) Beta receptors

C) Late sodium current

D) SA node pacemaker current

D. SA node pacemaker current

Ivabradine is mainly used in angina therapy in which way?

A) Prophylactically

B) Direct acute relief

C) Immediate nitrate reversal

D) Bronchospasm treatment

A. Prophylactically

Which adverse effect is associated with ivabradine due to reduced heart rate?

A) QT prolongation

B) Bradycardia

C) Constipation

D) Headache

B. Bradycardia

A patient on ivabradine reports unusual visual brightness. Which adverse effect does this represent?

A) Reflex tachycardia

B) Bronchoconstriction

C) Visual brightness changes

D) Ototoxicity

C. Visual brightness changes

Which set contains adverse effects of ivabradine?

A) Headache and hypotension

B) Bradycardia and visual brightness changes

C) Constipation and QT prolongation

D) Bronchoconstriction and wheezing

B. Bradycardia and visual brightness changes

Which antianginal drug reduces heart rate without directly blocking beta receptors?

A) Ivabradine

B) Propranolol

C) Atenolol

D) Metoprolol

A. Ivabradine

A patient asks why several antihypertensive drugs also help angina. Which explanation is best?

A) They increase cardiac oxygen demand

B) They increase heart work

C) They decrease heart workload

D) They increase venous return

C. They decrease heart workload

Which antianginal option most directly decreases venous return?

A) Metoprolol

B) Nitroglycerin

C) Ranolazine

D) Ivabradine

B. Nitroglycerin

Which of the following is a common direct or reflex effect of
nitroglycerin?
(A) Decreased heart rate
(B) Decreased venous capacitance
(C) Increased afterload
(D) Increased cardiac force
(E) Increased diastolic myocardial fiber tension

(D) Increased cardiac force

It increases cardiac contractile force because the decrease in blood pressure evokes a compensatory increase in sympathetic discharge.

In advising the patient about the adverse effects she may
notice, you point out that nitroglycerin in moderate doses
often produces certain symptoms. Which of the following
effects might occur due to the mechanism listed?
(A) Constipation due to reduced colonic activity
(B) Dizziness due to reduced cardiac force of contraction
(C) Diuresis due to sympathetic discharge
(D) Headache due to meningeal vasodilation
(E) Hypertension due to reflex tachycardia

(D) Headache due to meningeal vasodilation

Useful drugs for the prophylaxis of angina of effort include
(A) Amyl nitrite
(B) Esmolol
(C) Sublingual isosorbide dinitrate
(D) Sublingual nitroglycerin
(E) Verapamil

(E) Verapamil

esmolol is not going to work long enough

If a β blocker were to be used for prophylaxis in a patient,
what is the most probable mechanism of action in angina?
(A) Block of exercise-induced tachycardia
(B) Decreased end-diastolic ventricular volume
(C) Increased double product
(D) Increased cardiac force
(E) Decreased ventricular ejection time

(A) Block of exercise-induced tachycardia

In considering adverse effects of possible drugs for these conditions, you note that an adverse effect that nitroglycerin and prazosin have in common is
(A) Bradycardia
(B) Impaired sexual function
(C) Lupus erythematosus syndrome
(D) Orthostatic hypotension
(E) Weight gain

(D) Orthostatic hypotension

A 25-year-old man is admitted to the emergency department with a brownish cyanotic appearance, marked shortness of breath, and hypotension. He has needle marks in
both arms. Which of the following is most likely to cause
methemoglobinemia?
(A) Amyl nitrite
(B) Isosorbide dinitrate
(C) Isosorbide mononitrate
(D) Nitroglycerin
(E) Sodium cyanide

(A) Amyl nitrite

Nitrites, not nitrates, cause methemoglobin￾emia in adults

Another patient is admitted to the emergency department
after a drug overdose. He is noted to have hypotension and
severe bradycardia. He has been receiving therapy for hypertension and angina. Which of the following drugs in high
doses causes bradycardia?
(A) Amlodipine
(B) Isosorbide dinitrate
(C) Nitroglycerin
(D) Prazosin
(E) Verapamil

(E) Verapamil

A 45-year-old woman with hyperlipidemia and frequent
migraine headaches develops angina of effort. Which of
the following is relatively contraindicated because of her
migraines?
(A) Amlodipine
(B) Diltiazem
(C) Metoprolol
(D) Nitroglycerin
(E) Verapamil

(D) Nitroglycerin