nitroglycerine or verapamil in prinzmetal angina???? - USMLE Forums
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Old 07-19-2010
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Drug nitroglycerine or verapamil in prinzmetal angina????

guys i have a query... i had a question which mentioned of prinzmetal angina... there were two options left... 1) verapamil and 2) nitroglycerine... wat shud be chosen????
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Old 07-19-2010
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hmm.. nitroglycerin should be for rapid results like with an acute attack of angina. but if it isnt an acute attack n he just has unstable angina, then verapamil i think?
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Old 07-19-2010
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i would also choose verapamil
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i think 1st they give nitrates ( intravenous or sublingual) then they will give calcium channel blockers
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Old 07-19-2010
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the anwer was verapamil... i chose nitroglycerine but it was given verapamil... so moral of the story.... use verapamil in prinzmatal angina... ryt?????? bt why??? someone xplain in detail plzzz
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Old 07-19-2010
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Arrow Prinzmetal angina treatment

Prinzmetal agnina is due to coronary artery spasm and the treatment is with vasodilators and both calcium channel blockers and nitrates are good for this.

However, it depends on the question. There might some contraindication for the use of nitrates in that particular case and therefore they picked up verapamil.

Verapamil is generally not a good choice because it works on the heart muscle mainly while Nifedipine is mainly on blood vessels and it should be the better choice.
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Yep thats wat i was abt to post... That diltiazem or nifedipine would be abetter choice than verapamil because it doesnot act on blood vessels...
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@doctor F i looked in many places it says nitrates 1st then nifidipine

can u post the question plzzzz
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Old 07-19-2010
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Quote:
Originally Posted by ecgram View Post
@doctor F i looked in many places it says nitrates 1st then nifidipine

can u post the question plzzzz
A 45-year-old female complains of intermittent chest pain. It is neither worsened by exertion nor relieved by rest. During one such episode, an EKG is obtained but reveals no ST segment changes. What can be used to treat her symptoms?
A. Verapamil
B. Nitroglycern
C. Atenolol
D. Morhine
E. Aspirin
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Old 07-19-2010
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ANSWER GIVEN:

The correct answer is A.

This woman has symptoms consistent with Prinzmetalís angina. The treatment for the underlying coronary artery vasospasm is coronary artery vasodilatation by calcium channel blockers. All of the other answers listed can be used to treat unstable angina and myocardial infarction, but not Prinzmetalís angina.
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but i dont get it everywhere i see it says nitroglycerin and dipines
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must be an error in the bank!!! thats y i put this query up here so that it gets cleared in my mind... thanks to u all guys!!!
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Old 07-19-2010
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Here I jump again! I would like to bring into attention the coronary-steal-phenomenon issue, once more.

Perhaps, this is the exact reason why the correct answer to this question is verapamil, with respect to its AV-node rhythm controlling properties and the consequent relief of the cardiac muscle workload. Maybe the question wants to underline that, once the mechanism of vasospasm is the one that underlies the pathophysiology of this condition, our therapeutic approach should target away from this specific mechanism. It's possible that verapamil's smooth muscle relaxing properties act additively to this effect, but this is not the primary mechanism. On the contrary, direct vasodilatory properties of nitroglycerine may precipitate detouring of blood-flow from away from the coronaries.

What is more, in a more clinical point of view, verapamil is effective at controlling recurrencies of Prinzmetal's angina, but once the pain has started verapamil cannot ablate it.

Just some thoughts, though...
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see if this make sense the use of nitroglycerin in the pt with angina ----- there heart is ischemic and the vessels are maximally dilated because no energy (ATP) there is already adenosine present which is responsible for the vasodilation so giving NO doesnt do anything to the coronary vasculature
they give Nitroglycerin because it decreases the preload, so u can decrease the oxygen demand on the heart
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hmm.. i still think it's verapamil because i was always under the impression that nitrigylecrin was given to relieve acute pain (within 5 seconds) n CCBs are for control of pain n in this case for the variant intermittent chest pain.

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Old 07-19-2010
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people ,there was no mistake. Calcium blockers are the drug of choice to treat Printzmetal angina. Agree 100% with Dr Seetal. Anyway I saw it on first aid and Goljan rapid review. Unfortunately I don't know exactly why!
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Old 07-19-2010
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Guys, I think I have a little idea why: nitrates cause most of the time venodilation while ca blockers cause vasodilation of the coronorary arteries. Since we have coronoray artery spasm in Printzmetal ,so ca blockers are the better choice
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Old 07-20-2010
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wow!!! so thats clear!!! VErapamil for prinzmetal angina
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i understand but verapamil doesnt act on blood vessels dipine which are dihydropyridine ca+2 channnel blockers act on blood vessel
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Old 07-20-2010
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@ sam 01 in goljan they just mention nitroglycerin and calcium channel blocker

in first Aid if u listen to doctors in training video he says its dipines are the DOC for prinzmetals angina
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Old 07-20-2010
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Anyway ,every book i read didnt make any exception.One more thing ,the fact that verapamil has more effect on the ventricule doesnt mean it can t act on blood vessel also ?? just an opinion
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Old 07-20-2010
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in kaplan and DIT they said it only acts on heart so .......
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Old 07-21-2010
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Quote:
Originally Posted by ecgram View Post
in kaplan and DIT they said it only acts on heart so .......
it says it acts on the heart, not that it acts ONLY on the heart... right..
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Old 07-28-2010
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Quote:
Originally Posted by Seetal View Post
hmm.. nitroglycerin should be for rapid results like with an acute attack of angina....then verapamil
+1
In real life I would choose (and I did) nitro at the first - and realy it is works OK, only then calcium channel blockers can be use... I think it is very very confused question. Hmm there is no info that nitro was used before... Any cardiologist here? I think this is not correct question (or answer) and I would like to hear cardiologist's opinion.

Thank you doctorF for the question. Where did you find it?
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  #25  
Old 07-29-2010
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Default hi

i just finished pharmaco kaplan videos n here's what the dr had to say about Nitroglycerin n Verapamil.

Nitroglycerin is used in emergencies because long-term use can cause cyanide poisoning.

verapamil is DOC for prinzmetal's angina because it's CCB effect is mostly on the heart n doens't cause much direct change to the blood vessels (hypotension).

its not in the kaplan notes, but its mentioned in the videos.
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Old 07-30-2010
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Quote:
Originally Posted by Seetal View Post
i just finished pharmaco kaplan videos n here's what the dr had to say about Nitroglycerin n Verapamil.

Nitroglycerin is used in emergencies because long-term use can cause cyanide poisoning.

verapamil is DOC for prinzmetal's angina because it's CCB effect is mostly on the heart n doens't cause much direct change to the blood vessels (hypotension).

its not in the kaplan notes, but its mentioned in the videos.
nitroprusside causes cyanide toxicity not nitroglycerin, nitrItes are used to treat cyanide toxicity because it forces formation of cyanomethemoglobin pulling the cyanide away from complex 4 of ETC because its higher affinity for cyanide
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Old 07-30-2010
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Quote:
Originally Posted by Androide89 View Post
nitroprusside causes cyanide toxicity not nitroglycerin, nitrItes are used to treat cyanide toxicity because it forces formation of cyanomethemoglobin pulling the cyanide away from complex 4 of ETC because its higher affinity for cyanide
YES, nitroprusside. thanks for correcting me.
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