Practical lesson

ANTIANGINAL. HYPOLIPIDEMIC DRUGS

Name_____________________

Group_____________________

III course Medical Faculty

Date________________
______
 Choose and EXPLAIN the correct answer

1. A 57-year-old patient with coronary artery disease has been administered an anti-
anginal agent that activates guanylate cyclase and accumulates myocardial cGMP.
What drug is it?
A. Isosorbide mononitrate
B. Dipyridamole
C. Panangin
D. Validol
E. Verapamil

2. After a serious psychoemotional stress a 48-year-old patient suddenly developed

acute heart ache irradiating to the left arm. Nitroglycerine relieved the pain attack
after 10 minutes. What is the leading pathogenetic mechanism of this process
development?
A.Spasm of coronary arteries
B.Increase in myocardial oxygen consumption
C.Dilatation of peripheral vessels
D.Obstruction of coronary vessels
E. Compression of coronary vessels

3. A patient with Raynaud disease was treated with niphedipine. What is the
mechanism of action of this drug?
A. Blockade of B-adrenoceptors
B. Blockade of alpha adrenoceptors
C. Decrease in neurotransmitter amount
D. Calcium channels’ blockade
E. Blockade of central M-cholinoceptors.

4. To prevent the onset of myocardial infarction in a patient with angina pectoris

aspirin was used. Due to which of listed effects aspirin is beneficial in this case?
A. Antiinflammatory
B. Antiplatelet
C. Analgesic
D. Antipyretic
E. Ulcerogenic.
5. After a tooth extraction a patient felt persistent pain behind his breast bone. After
sublingual intake of an antianginal drug the pain behind the breast bone disappeared,
but the patient complained of headache and dizziness. What drug are these properties
typical for?
A. Validol
B. Verapamil
C. Nitroglycerin
D. Metoprolol
E. Propranolol.

6. In complex treatment of a patient with angina pectoris non- narcotic analgesic

exerting antiplatelet activity was included. Point out this agent.
A. Meperidine
B. Morphine
C. Tramadol
D. Metamizole
E. Aspirin

7. A 72-year woman suffering from angina pectoris was treated by propranolol

(anaprilinium). On the background of the treatment cough with bronchospastic
components was developed. Doctor replaced propanolol with metoprolol. This
resulted in abolishing of respiratory disturbances. What is the reason for the
beneficial effect of metoprolol?
A. Block of M-cholinoceptors
B. Absence of action upon β2- adrenoceptors
C. Stimulating of M-cholinoceptors
D. Inhibition of m-cholinireceptors
E. Absence of action on α- adrenoceptors

8. A patient with myocardial infarction was treated with intravenous infusion of

heparin. What is the goal of this drug administration?
A. To cause the lysis of thrombus directly
B. To transform plasminogen into plasmin
C. To prevent further thrombosis
D. To prevent platelets activation
E. To decrease the area of necrosis

9. It is necessary to prevent the onset of myocardial infarction in patient with angina

pectoris. Choose the drug with antiplatelet and vasodilating effects.
A. Ticlopidine
B. Dipiridamole
C. Aspirin
D. Nifedipine
E. Verapamil

10. Patient complains of weakness, dyspnea, low extremities oedema. Diagnosis:

chronic cardiac insufficiency. What medicine should be prescribed first of all?
A. Digitoxin
B. Caffeine
C. Papaverine
D. Propranolol
E. Raunatin

11. Myocardial infarction patient was treated with streptokinase. What is the
mechanism of thrombolytic action of this drug?
A. Formation of active complex with proactivator of plasminogen
B. Direct activation of plasminogen
C. Prevention of prothrombin conversion to thrombin
D. Prevention of fibrin formation
E. Direct lysis of thrombus

12. 72-year-old patient with angina pectoris was prescribed dipyridamole.

Administration of drug resulted in worsening of patient condition and doctor
substituted dipyridamole by long acting organic nitrate. What was the most probable
cause of worsening?
A. Lack of coronary vessels dilation
B. Increase in oxygen demand
C. “Coronary steal phenomenon”
D. Decrease in arterial pressure
E. Decrease in venous pressure

13. A patient who had myocardial infarction was prescribed 75 mg of acetylsalicylic

acid a day. What is the purpose of this administration?
A. Reduction of platelet (thrombocyte) aggregation
B. Inflammation reduction
C. Pain relief
D. Temperature reduction
E. Coronary vessel dilatation

14. Anapriline (Propranolol) therapy caused positive effect in the dynamic of the
disease of a 44-year-old woman suffering from stenocardia (angina pectoris). What is
the main mechanism of the effect of this medicine?
A. Blockade of β-adrenoreceptors and decrease myocardial requirements to the
oxygen.
B. Decrease of oxidative exchange in myocardium due to enzyme blockade of
Krebs' cycle
C. Decreased power inputs of myocardium due to reduced loading
D. Increased oxygen supply to the myocardium
E. Decreased need in increasing of oxygen supply to the myocardium

15. A patient suffering from coronary artery disease had taken a certain drug many
times a day in order to arrest stenocardia attacks. Overdose of this drug finally caused
intoxication. Objectively: cyanotic skin and mucous membranes, dramatic fall in the
arterial pressure, tachycardia, respiration inhibition. Blood has increased
concentration of methemoglobin. The drug the patient had taken relates to the
following group:
A. Organic nitrates
B. Alpha-adrenoceptor blockers
C. Calcium channel blockers
D. Adenosine drugs
E. Myotropic spamolytics
16. A patient suffers from stenocardia and takes isosorbide mononitrate. He was
prescribed a complementary drug with disaggregating effect. What drug is it?
A. Acetylsalicylic acid
B. Nitroglycerine
C. Propranolol
D. Nifedipine
E. Validol

17. A patient with coronary artery disease was admitted to the cardiological
department. For stenocardia (angina pectoris) prevention a drug from the group of
beta-adrenoceptor blockers was administered. What drug is it?
A. Metoprolol
B. Atropine sulfate
C. Morphine hydrochloride
D. Oxytocin
E. Furosemide

18. A patient with frequent attacks of stenocardia was prescribed sustak-forte to be

taken one tablet twice a day. At first the effect was positive but on the second day
stenocardia attacks resumed. What can explain inefficiency of the prescribed drug?
A. Tachyphylaxis
B. Cumulation
C. Sensibilization
D. Idiosyncrasy
E. Dependence
 CLINICAL CASES

1. During screening of antianginal agents three groups of rats were administered with
drugs that reduce myocardial oxygen demand. Drug A. decreased the heart rate and
had no influence on coronary arteries. Drug B. decreased the heart rate and dilated
coronary arteries. Drug C. caused tachycardia, dilated coronary and peripheral
arteries. What pharmacological groups do these drugs belong to? Explain your
answer

2. A patient with coronary heart disease, felt acute pain behind his sternum and took
the medicine under his tongue for this. After a few minutes, the pain was decreased,
but headache, dizziness, and weakness appeared. The patient lost his consciousness
and fellt. The ambulance team diagnosed acute hypotension. What drug did the
patient take? What are the rules of the drug administration he neglected? How can
these complications be eliminated?

3. Patient with coronary heart disease used an antianginal agent in the form of a skin
patch. 8 hours after gluing the patch, he developed an attack of angina pectoris. The
patient was forced to take the same supplement in tablets under the tongue. What
medicine did the patient use in the form of a patch? Why it was ineffective?

4. Drugs A, B, C and D provide their lipid-lowering effect by different mechanisms

of action. What can you say about the groups these drugs belong to, if it is known that
drug A reduces the activity of HMG CoA reductase and increases the number of LDL
receptors in the liver; drug B increases the activity of LP of vascular endothelial
lipase and the number of LDL receptors in the liver; drug C inhibits lipolysis in
adipose tissue and increases the activity of LP lipase in vascular endothelium, and
drug D increases the conversion of cholesterol to bile acids, which is accompanied by
an increase in the amount of LDL in the liver and the activity of HMG CoA
reductase. What changes in the lipid spectrum of blood plasma will lead when these
drugs will be administered?

5. A 45-year-old patient with ischemic heart disease and severe atherosclerosis was
taking a drug that lowers blood plasma cholesterol. After 3 weeks of regular therapy,
the patient developed sharp weakness, muscle pain, transaminase activity in the blood
increased. What drug did the patient take? What is the mechanism of this
complication? Would you change the drug therapy, why or why not?