Which of the following drugs is most likely to precipitate angina ?
**Core Concept**
The question is testing the understanding of the pathophysiology of angina pectoris, specifically the factors that contribute to its precipitation. Angina is caused by transient myocardial ischemia, which can be triggered by various factors, including coronary artery disease, increased myocardial oxygen demand, and vasospasm.
**Why the Correct Answer is Right**
The correct answer is likely to be a drug that increases myocardial oxygen demand, either by increasing heart rate, contractility, or both. This can be achieved through the use of beta-agonists, which stimulate the beta-1 adrenergic receptors in the heart, leading to increased heart rate and contractility.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is likely a beta-blocker, which would actually decrease myocardial oxygen demand by reducing heart rate and contractility, making it an unlikely choice to precipitate angina.
**Option B:** This option is likely a calcium channel blocker, which would also decrease myocardial oxygen demand by reducing contractility and heart rate, making it an unlikely choice to precipitate angina.
**Option C:** This option is likely a nitrate, which would actually decrease myocardial oxygen demand by dilating coronary arteries and reducing preload, making it an unlikely choice to precipitate angina.
**Clinical Pearl / High-Yield Fact**
It's essential to remember that beta-agonists, such as those used in asthma or COPD, can precipitate angina in patients with pre-existing coronary artery disease due to their effects on increasing heart rate and contractility.
**Correct Answer:** C.