Q: 37 year old male with PMH of hypertension is admitted to ICU with chest pain. After angiogram, has been diagnosed with Prinzmetal's angina. Which one medicine should be prescribed with caution for his hypertension?

Answer: Beta-Blocker

In Prinzmetal's angina beta blockers can cause further spasm making it worse. Alike in cocaine overdose, beta-blockers leave the alpha1 receptors available for binding by various endogenous hormones.

Also, aspirin is not indicated with clean coronaries. It is postulated that aspirin can effect the vasodilator mechanisms in the endothelium since it is an inhibitor of prostacyclin production as well as nitric oxide.