Angina pectoris and has been taking isosorbide dinitrate for several years.

Your patient has angina pectoris and has been taking isosorbide dinitrate for several years. However, recently they are experiencing intermittent chest pain especially when the patient increases their physical activity.  Which of the following statements are TRUE with regard to this case?

  a.

The primary mechanism of action of isosorbide dinitrate is to increase nitric oxide which leads to the activation of guanylyl cyclase, production of cGMP, and activation of protein kinase that phosphorylates specific cellular proteins that mediate vascular smooth muscle cell relaxation.

  b.

The addition of a beta-adrenergic receptor antagonist is a reasonable next step in treating angina.

  c.

Nitrates decrease preload on the heart thereby reducing oxygen demand.

  d.

The patient should be cautioned about getting out of bed quickly because orthostatic hypotension is a common side effect of isosorbide dinitrate.

  e.

All of the above.