Chronic Stable Angina
E.H. is a 45-year-old African American man who recently moved to the community from another state. He requests renewal of a prescription for a calcium channel blocker, prescribed by a physician in the former state. He is unemployed and lives with a woman, their son, and the woman’s 2 children. His past medical history is remarkable for asthma and six “heart attacks” that he claims occurred because of a 25-year history of drug use (primarily cocaine). He states that he used drugs as recently as 2 weeks ago. He does not have any prior medical records with him. He claims that he has been having occasional periods of chest pain. He is unable to report the duration or pattern of the pain. Before proceeding, explore the following questions: What further information would you need to diagnose angina (substantiate your answer)? What is the connection between cocaine use and angina? Identify at least three tests that you would order to diagnose angina.
1. List specific goals of treatment for E.H.
2. What dietary and lifestyle changes should be recommended for this patient?
3. What drug therapy would you prescribe for E.H. and why?
4. How would you monitor for success in E.H.?
5. Describe one or two drug–drug or drug–food interactions for the selected agent.
6. List one or two adverse reactions for the selected agent that would cause you to change therapy.
7. What would be the choice for the second-line therapy?
8. Discuss specific patient education based on the prescribed first-line therapy.
9. What over-the-counter and/or alternative medications would be appropriate for E.H.?