19 在治療心絞痛病人時，下列那種合併用藥最不妥當？
(A) Nitrate 與 Metoprolol
(B) Nifedipine 與 Atenolol
(C) Verapamil 與 Metoprolol
(D) Nifedipine 與 Nitrate

個人見解/解題思路:

(A) Beta- Blocker(首選) + 急性發作用藥，合理

(B、C) Nifedipine在周邊的抑制作為較強，Verapamil在心臟的抑制作為較強，兩者與Selective Beta- Blocker 併用，Verapamil與Selective Beta- Blocker 併用更容易造成AV blocking->bradycardia，題目問的是"最不妥當"，當然選(C)

(D)CCB (同樣是首選，要按臨床情況選擇)+ 急性發作用藥，合理

引用 The handbook of applied therapeutics 9th

ㅤㅤ

以下是ESC 2024 Chronic Coronary Syndromes 的指引

The current empirical paradigm for the selection of antianginal medical therapy has consisted of a hierarchical, stepwise approach including first-line (beta-blockers, CCBs) and second-line drugs (long-acting nitrates, nicorandil, ranolazine, ivabradine, trimetazidine).^1,514 This task force reinforces the concept that medical therapy for symptom control in CCS should be tailored to each patient’s haemodynamic profile (BP, heart rate), comorbidities (particularly presence of HF), concomitant medications with potential drug interactions, and preferences, also taking into account the pathophysiological basis of myocardial ischaemia in each patient, as well as local availability of different drugs.^515,516 For many patients with CCS, initial drug therapy should include a beta-blocker and/or a CCB. Other antianginal drugs (long-acting nitrates, ivabradine, nicorandil, ranolazine, trimetazidine) can be added on top of a beta-blocker and/or a CCB, or as a part of initial combination therapy in appropriately selected patients (Figure 9).
 

ㅤㅤ

另外閒話一提，有分為anti-ischaemic drugs和Antithrombotic drugs詳細可以讀一下ESC的指引https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehae177/7743115?login=false#479845305

ㅤㅤ