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pharmacology
01-22-2005, 11:36 PM
A 63-year-old man presents to the emergency department with precordial chest pain. He states that this pain is often precipitated by stress or exertion and is generally relieved quickly by rest and/or nitrates. On examination, there is electrocardiographic evidence of ischemia during stress testing. Angiography demonstrates narrowing of several major heart vessels. Which of the following would be most likely to worsen the patient's angina?

A. Acebutolol
B. Atenolol
C. Metoprolol
D. Nadolol
E. Propranolol

Asclepius1
02-18-2005, 08:46 PM
I'll go with Propranolol, due to its greater tendency to increase plasma LDL and triglycerides.

pharmacology
02-21-2005, 11:12 PM
A 63-year-old man presents to the emergency
department with precordial chest pain. He states that this pain is
often precipitated by stress or exertion and is generally relieved
quickly by rest and/or nitrates. On examination, there is
electrocardiographic evidence of ischemia during stress testing.
Angiography demonstrates narrowing of several major heart vessels.
Which of the following would be most likely to worsen the patient's
angina?

A. Acebutolol
B. Atenolol
C. Metoprolol
D. Nadolol
E. Propranolol


The correct answer is A. The patient meets the criteria for
exertional angina: precordial chest pain precipitated by stress or
exertion, generally quickly relieved by rest and/or nitrates. The
beta-adrenergic blocking agents prevent angina by decreasing myocardial
oxygen requirements during exertion and stress through the reduction of
heart rate, myocardial contractility, and blood pressure. Beta-blockers
are the only antianginal agents that have been proven to prolong life in
patients with coronary disease and are considered to be first-line
agents in the treatment of chronic angina. Beta blockers with intrinsic
sympathomimetic activity (acebutolol and pindolol) are generally not
recommended for patients with angina since they may exacerbate the
angina in some patients.

Currently in the U.S., agents indicated for treatment of angina
include atenolol (choice B), metoprolol (choice C),
nadolol (choice D), and propranolol (choice E).







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