CV: DRUGS FOR ANGINA PECTORIS

1.

DRUG
Nitrates
a. Nitroglycerin

ADMINITRATION

Amyl nitrite
Isosorbide dinitrate,
mononitrate
Calcium Channel
Blockers

Nifedipine,
Amlodipine,
Nicardipine,

Diltiazem, Verapamil
Blockers

Propranolol,
Metoprolol, Atenolol,
Nadolol,

Timolol, Acebutolol,
Betaxolol, Bisoprolol,

Pindolol, LabetALOL,
Penbutolol

Sodium Channel Blocker

Ranolazine

b.
c.
1.

2.

3.

SL, spray, transdermal

patch, oral (BA: 10-20%),
IV infusion
SL

Avoid 1st pass

Achieve therapeutic
blood level rapidly

Onset: 2 min
Inhalation
SL, oral
-

Alone or in combination

INDICATION

Cornerstone of angina
therapy, most commonly
used
All forms of angina

MOA
converted to nitric oxide (NO) inc.
cGMP
smooth muscle relaxation
vasodilation

Must be taken at the onset

of anginal pain or prior to
Px anginal episodes
Relieve Sx of acute angina
Px of angina
NOT for acute attack
DOC for Prinzmetals angina
relieve and Px the
primary cause of variant
anginafocal coronary
artery spasm

DOC stable angina

For improved exercise
tolerance

HR, contraction CO O2
demand

Tx chronic angina
Tx refractory angina

Inhibits late phase Na+ current

O2 supply intracellular Na and
Ca improved diastolic fx

ADVERSE EFFECT

orthostatic hypotension,
tachycardia and throbbing
headache
Tolerance

tissue SH

oxygen free radicals

Tx: nitrate-free
peroid: 8 hours bet.
doses

cardiac arrest, bradycardia,

AV block and HF ( Ca2+
influx)

in diastolic volume and

ejection time