A 44-year-old man reports recurrent episodes of rest angina occurring at night, relieved by sublingual nitroglycerin. Between episodes the ECG is normal and troponins are negative. During an episode, transient ST segment elevation is recorded. Ambulatory monitoring confirms episodic coronary spasm. Which drug class should be avoided in his long-term management?

• A Non-dihydropyridine calcium channel blockers
• B Long-acting nitrates
• C Statin therapy
• D Beta blockers without intrinsic sympathomimetic activity ✓

Explanation

Vasospastic (Prinzmetal) angina is treated with calcium channel blockers and nitrates, which dilate the spastic segment. Non-selective beta blockade removes beta-2 mediated vasodilation and leaves alpha-mediated vasoconstriction unopposed, potentially worsening spasm, so plain beta blockers are avoided. Statins improve endothelial function and are beneficial. Aspirin at high doses may also aggravate spasm by inhibiting prostacyclin, but among the options given, non-selective beta blockers are the classic contraindicated class.

Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.

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