ATI MED SURG Pathophysiology, Diagnosis, and
Management Acute Coronary Syndrome & Stable Angina:
Questions and answers 2025/2026
What is the first-line pharmacological treatment for stable angina? - correct answer
Beta-blockers
Why should beta-blockers not be abruptly discontinued? - correct answer Risk of
rebound tachycardia or exacerbation of angina
What is the primary risk of combining a non-DHP CCB with a beta-blocker? - correct
answer Risk of bradycardia and atrioventricular (AV) block
Which type of calcium channel blockers should be avoided due to reflex tachycardia? -
correct answer Short-acting CCBs (e.g., nifedipine IR)
What is the main purpose of a 10-12 hour nitrate-free period? - correct answer To
prevent the development of nitrate tolerance
What is a major drug interaction for nitrates? - correct answer PDE-5 inhibitors (e.g.,
sildenafil, tadalafil), which can cause severe hypotension
How should nitroglycerin SL spray be administered? - correct answer Onto or under
the tongue at 5-minute intervals for up to 3 doses
What instruction should be given to a patient before using nitroglycerin SL spray? -
correct answer Sit down to prevent syncope
How should a nitroglycerin patch be applied? - correct answer Apply QAM, remove
QHS, rotate sites on the upper arms or chest, and avoid areas below elbows or knees
What is the target LDL level for patients with cardiovascular risk? - correct answer <
1.8 mmol/L
, What is the target resting heart rate for patients on therapy? - correct answer
Approximately 60-70 bpm
How is stable angina clinically defined? - correct answer Exercise-induced chest pain
with no/minimal ECG changes and no troponin changes
What medications should be stopped in patients with stable angina? - correct answer
HRT and NSAIDs
What is the definition of unstable angina? - correct answer Chest pain occurring at rest
with ST depression but no troponin changes
What is the difference between STEMI and NSTEMI on an ECG? - correct answer
STEMI shows ST-elevation, while NSTEMI shows ST-depression
What is the preferred treatment for STEMI if a facility is available? - correct answer
PCI performed within 120 minutes
What is the standard duration for DAPT following a STEMI/NSTEMI? - correct answer
One year
What is the primary goal of short-acting nitrates in ACS? - correct answer Acute
symptom relief
What is the primary goal of long-acting nitrates in stable angina? - correct answer
Chronic prevention of symptoms
Why should nitroglycerin SL spray not be shaken? - correct answer Shaking creates
air bubbles that can result in an incomplete dose
Management Acute Coronary Syndrome & Stable Angina:
Questions and answers 2025/2026
What is the first-line pharmacological treatment for stable angina? - correct answer
Beta-blockers
Why should beta-blockers not be abruptly discontinued? - correct answer Risk of
rebound tachycardia or exacerbation of angina
What is the primary risk of combining a non-DHP CCB with a beta-blocker? - correct
answer Risk of bradycardia and atrioventricular (AV) block
Which type of calcium channel blockers should be avoided due to reflex tachycardia? -
correct answer Short-acting CCBs (e.g., nifedipine IR)
What is the main purpose of a 10-12 hour nitrate-free period? - correct answer To
prevent the development of nitrate tolerance
What is a major drug interaction for nitrates? - correct answer PDE-5 inhibitors (e.g.,
sildenafil, tadalafil), which can cause severe hypotension
How should nitroglycerin SL spray be administered? - correct answer Onto or under
the tongue at 5-minute intervals for up to 3 doses
What instruction should be given to a patient before using nitroglycerin SL spray? -
correct answer Sit down to prevent syncope
How should a nitroglycerin patch be applied? - correct answer Apply QAM, remove
QHS, rotate sites on the upper arms or chest, and avoid areas below elbows or knees
What is the target LDL level for patients with cardiovascular risk? - correct answer <
1.8 mmol/L
, What is the target resting heart rate for patients on therapy? - correct answer
Approximately 60-70 bpm
How is stable angina clinically defined? - correct answer Exercise-induced chest pain
with no/minimal ECG changes and no troponin changes
What medications should be stopped in patients with stable angina? - correct answer
HRT and NSAIDs
What is the definition of unstable angina? - correct answer Chest pain occurring at rest
with ST depression but no troponin changes
What is the difference between STEMI and NSTEMI on an ECG? - correct answer
STEMI shows ST-elevation, while NSTEMI shows ST-depression
What is the preferred treatment for STEMI if a facility is available? - correct answer
PCI performed within 120 minutes
What is the standard duration for DAPT following a STEMI/NSTEMI? - correct answer
One year
What is the primary goal of short-acting nitrates in ACS? - correct answer Acute
symptom relief
What is the primary goal of long-acting nitrates in stable angina? - correct answer
Chronic prevention of symptoms
Why should nitroglycerin SL spray not be shaken? - correct answer Shaking creates
air bubbles that can result in an incomplete dose
