AANP Family Nurse Practitioner (FNP) Certification ExamPlanHard
A 72-year-old male with a history of hypertension, hyperlipidemia, and stable angina presents for routine follow-up. He reports occasional mild chest pain with exertion, relieved by rest. He is currently on aspirin, atorvastatin, and metoprolol. His blood pressure is 130/80 mmHg, and heart rate is 62 bpm. Which of the following is the most appropriate pharmacological management adjustment to optimize his angina control?
- AIncrease the dose of metoprolol.
- BAdd sublingual nitroglycerin as needed.
- CAdd isosorbide mononitrate daily.
- DSwitch metoprolol to diltiazem.
Show answer & explanationAnswer & explanation
Correct answer: B. Add sublingual nitroglycerin as needed.
For stable angina, sublingual nitroglycerin (SL NTG) is the standard and most appropriate first-line treatment for acute symptom relief. It provides rapid vasodilation and relief of chest pain. While chronic management involves agents like beta-blockers, SL NTG is essential for 'as needed' relief.
Why the other options are wrong
- A. While increasing metoprolol might improve angina control, the patient already has a heart rate of 62 bpm, suggesting further beta-blockade might lead to bradycardia or other side effects. SL NTG is specific for acute relief.
- C. Isosorbide mononitrate is a long-acting nitrate used for daily prophylaxis of angina, not for acute relief, and typically added after optimizing beta-blocker therapy or if symptoms persist.
- D. Switching from a beta-blocker to a non-dihydropyridine calcium channel blocker like diltiazem is an option if beta-blockers are contraindicated or not tolerated, but it's not the first step for acute symptom management in a patient already on a beta-blocker.
Stable Angina Acute Tx
Acute symptom relief for stable angina is primarily achieved with sublingual nitroglycerin, which rapidly dilates coronary arteries and reduces myocardial oxygen demand.
- Sublingual nitroglycerin is the first-line for acute angina attacks.
- It provides rapid relief (within minutes).
- Patients should be educated on proper use and when to seek emergency care.
Memory trick: For Angina's Sting, Nitroglycerin Brings Quick Relief!