Which of the following drugs is used to manage Prinzmetal angina?

Appeared in: PGICH Noida NO-2025

Explanation

Prinzmetal angina is caused by coronary artery vasospasm, not by stable atherosclerotic plaques.
Nifedipine is a dihydropyridine calcium channel blocker (CCB).
CCBs work by relaxing the smooth muscles of the coronary arteries, causing them to dilate.
This vasodilation directly counteracts the spasm, increases blood flow to the heart, and relieves the anginal pain.
Therefore, calcium channel blockers are the first-line treatment for managing Prinzmetal angina.

Option B: Captopril is an ACE inhibitor used for hypertension and heart failure. It does not have a direct vasodilatory effect on coronary arteries to relieve vasospasm.
Option C: Propranolol is a non-selective beta-blocker and is contraindicated in Prinzmetal angina. It can block beta-2 adrenergic receptors (which cause vasodilation), leading to unopposed alpha-adrenergic vasoconstriction, which can worsen the coronary spasm.
Option D: Ranolazine is a late sodium current inhibitor used as an add-on therapy for chronic stable angina. Its mechanism is not targeted at relieving acute vasospasm.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pharmacological management of Prinzmetal (variant) angina as background academic context rather than a clinical decision trigger.
Accurate diagnosis is crucial. Mistaking Prinzmetal angina for stable angina and prescribing a beta-blocker can have severe adverse effects, worsening the condition.
Nurses play a key role in educating patients to avoid triggers like smoking, cocaine use, and significant stress, which can precipitate vasospastic episodes.
When administering Nifedipine, nurses must monitor for hypotension, dizziness, and peripheral edema, which are common side effects.

How to Approach the Question

First, identify the specific condition mentioned in the question: 'Prinzmetal angina'.
Recall the pathophysiology of this condition. Prinzmetal angina is caused by coronary artery vasospasm, not by fixed blockages.
Analyze the drug options based on their mechanism of action and how they would affect a vasospasm.
Nifedipine is a calcium channel blocker that causes vasodilation, directly treating the spasm.
Captopril (ACE inhibitor) primarily affects blood pressure and fluid balance, not acute vasospasm.
Propranolol (beta-blocker) is contraindicated as it can worsen the spasm.

Concept Tested & Keywords

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E6 Pharmacology Katzung 16e pp. 320-322, 318-320

E6 Pharmacology Nursing Lilley 11e Part 2 p. 60-62

Practise the full PGICH Noida NO-2025

Attempt every question from this paper in a timed mock, then review the full solution for each one.