Medication appropriate to treat an acute anginal attack is

NHM UP Staff Nurse-2021 Shift-1st

Pharmacology

Easy

Appeared in: NHM UP Staff Nurse-2021 Shift-1st

Explanation

Nitroglycerin is the drug of choice for treating an acute anginal attack due to its rapid onset of action, typically providing relief within 2-5 minutes.
It is a potent vasodilator that works by relaxing vascular smooth muscle, which dilates coronary arteries and systemic veins.
This action reduces both preload (venous return) and afterload (systemic resistance), decreasing the heart's workload and myocardial oxygen demand, thereby relieving ischemic chest pain.

Option A: Propranolol is a non-selective beta-blocker. It is used for long-term prevention of angina, not for an acute attack, because its onset of action is too slow to provide immediate relief.
Option B: Nadolol is a non-selective beta-blocker. Like other beta-blockers, it is intended for long-term management and prevention of anginal episodes, not for the immediate treatment of an acute attack.
Option C: Atenolol is a cardioselective beta-blocker. Its role is in the prophylactic treatment of angina by reducing the heart's workload over time. It is not effective for acute relief.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pharmacological management of acute angina pectoris as background academic context rather than a clinical decision trigger.
Patient education is a key nursing responsibility. The nurse must teach the patient how to correctly administer sublingual nitroglycerin, the dosing protocol (up to 3 tablets, 5 minutes apart), and to call for emergency services if pain persists.
Nurses must assess the patient's blood pressure before and after giving nitroglycerin, as it can cause significant hypotension. The patient should be advised to sit or lie down to prevent falls from dizziness.
A critical safety check is to ask male patients about the recent use of phosphodiesterase-5 inhibitors (e.g., sildenafil) before administering nitroglycerin. Co-administration is contraindicated as it can cause life-threatening hypotension.

How to Approach the Question

First, identify the key term in the question stem: 'acute anginal attack'. This immediately signals the need for a medication with a rapid onset of action for immediate symptom relief.
Next, classify the medication options provided. Propranolol, Nadolol, and Atenolol are all beta-blockers.
Nitroglycerin is a nitrate.
Recall the primary therapeutic roles of these drug classes in managing angina. Nitrates (especially sublingual) are used for acute relief, while beta-blockers are used for long-term prophylaxis (prevention).
Based on this distinction, conclude that Nitroglycerin is the only appropriate choice for treating an acute attack.
Eliminate the beta-blocker options as they are used for prevention and have a slower onset of action.

Concept Tested & Keywords

Concept Tested: Pharmacological management of acute angina pectoris.
Stem keywords: medication, acute anginal attack
Lead-in keywords: appropriate to treat
Clinical cues: The term 'acute attack' is a critical cue, indicating the need for a medication with a rapid onset of action for immediate symptom relief.

Q5rAhDi_idoRYoWB0osV7D

E6 Pharmacology Nurses Shanbhag 3e p. 112-114

E6 Medicine Harrison 22e Part 2 p. 4-6

E6 Pharmacology Nursing Lilley 11e Part 2 p. 58-60