Review Practice Questions 3

Drugs Used to Treat Angina Pectoris > Pharmacology

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Practice Questions 3

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Question 1:

A client with angina has been given a prescription for a calcium channel blocker. The nurse knows that this class of drugs is used to treat which type of angina?

A. Effort B. Unstable C. Crescendo D. Vasospastic

Answer and Explanation

Choice A:

ffort (stable) angina occurs during physical activity or emotional stress due to fixed atherosclerotic plaque limiting coronary blood flow. First-line treatment includes beta blockers and nitrates to reduce myocardial oxygen demand; calcium channel blockers may be adjunct therapy if beta blockers are contraindicated.

Choice B:

Unstable angina is characterized by crescendo pain, unpredictability, and potential progression to myocardial infarction. Treatment focuses on antiplatelet therapy, anticoagulation, nitrates, and revascularization. CCBs are not primary therapy because they do not address the underlying thrombotic or plaque instability mechanisms.

Choice C:

Crescendo angina is essentially a form of unstable angina, with progressively severe, frequent, or prolonged episodes. Similar to unstable angina, management targets plaque stabilization and oxygen supply-demand balance, not coronary spasm, making CCBs secondary or adjunct therapy at best.

Choice D:

Vasospastic angina is caused by sudden, reversible coronary artery vasospasm, often occurring at rest and sometimes associated with ST-segment elevation on ECG. Calcium channel blockers relax coronary smooth muscle, preventing or relieving these spasms, making them the treatment of choice. CCBs also improve myocardial oxygen delivery by reducing afterload and coronary resistance without significantly increasing heart rate.Rationales for incorrect answers:

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Question 2:

The nurse is caring for a client on the calcium channel blocker diltiazem (Cardizem). Which statement by the client reflects the need for additional client education?

A. “I can take this drug to stop an attack of angina.” B. “I understand that food and antacids alter the absorption of this oral drug.” C. “When the long-acting forms are taken, the drug cannot be crushed.” D. “This drug may cause my blood pressure to drop, so I need to be careful when getting up.”

Answer and Explanation

Choice A:

“I can take this drug to stop an attack of angina.” Diltiazem is a maintenance medication that prevents angina by reducing cardiac workload and myocardial oxygen demand over time. It is not a rapid-acting antianginal agent, so it cannot relieve acute chest pain. Clients should be instructed to use sublingual nitroglycerin or other prescribed fast-acting medications for acute attacks. Misunderstanding this distinction could result in delayed treatment of acute ischemia. This increases the risk of myocardial infarction or serious complications.Rationales for incorrect answers:

Choice B:

“I understand that food and antacids alter the absorption of this oral drug.” Oral diltiazem’s absorption can be affected by food and antacids, which may alter its bioavailability. Recognizing this supports safe and effective administration and demonstrates correct understanding.

Choice C:

“When the long-acting forms are taken, the drug cannot be crushed.” Extended-release diltiazem formulations are designed to release the drug slowly; crushing or splitting them can cause dose dumping, toxicity, or subtherapeutic effects, so this statement is accurate and requires no correction.

Choice D:

“This drug may cause my blood pressure to drop, so I need to be careful when getting up.” Hypotension and orthostatic changes are common with diltiazem due to its vasodilatory effect. This demonstrates awareness of a significant adverse effect and the need for safety precautions, making it correct patient education.

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Practice Questions 3

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