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Chapter 12: Drugs Used in the Treatment of Angina Pectoris

A 57-year-old woman presents to her primary care physician with a complaint of severe chest pain when she walks uphill in cold weather. The pain disappears when she rests. She has a 40-pack-year history of smoking but her plasma lipids are within the normal range. After evaluation and discussion of treatment options, a decision is made to treat her with 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

Nitroglycerin increases heart rate and venous capacitance and decreases afterload and diastolic fiber tension. It increases cardiac contractile force because the decrease in blood pressure evokes a compensatory increase in sympathetic discharge. The answer is D.

A 57-year-old woman presents to her primary care physician with a complaint of severe chest pain when she walks uphill in cold weather. The pain disappears when she rests. She has a 40-pack-year history of smoking but her plasma lipids are within the normal range. After evaluation and discussion of treatment options, a decision is made to treat her with nitroglycerin.

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

The nitrates relax many types of smooth muscle, but the effect on motility in the colon is insignificant. Nitroglycerin causes hypotension as a result of arterial and venous dilation. Dilation of arteries in the meninges has no effect on central nervous system function but does cause headache. The answer is D.

A 57-year-old woman presents to her primary care physician with a complaint of severe chest pain when she walks uphill in cold weather. The pain disappears when she rests. She has a 40-pack-year history of smoking but her plasma lipids are within the normal range. After evaluation and discussion of treatment options, a decision is made to treat her with nitroglycerin.

One year later, the ...

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