TREATMENT OF ANGINA PECTORIS

O2 delivery: vasodilators (nitrates, CCBs)

O2 demand: β-blockers, CCBs, pFOX inhibitors, lf sodium channel blockers
Nitrates Metabolic modulators/ pFOX (partial lf sodium channel blockers
β-blockers
Converted to nitric oxide (NO) cGMP Calcium Channel Blockers fatty acid oxidation) inhibitors spontaneous electrical pacemaker
No vasodilating effect
 smooth muscle relaxation O2 DOC for Prinzmetal’s angina Inhibits oxidation of fatty acid in activity in the SA node which is
HR, contraction, BP O2 demand
supply ischemic myocardium O2 demand controlled by the lf current HR
Nitroglycerin (Deponit NT, Transderm- Nifedipine (Adalat, Calcibloc) Propranolol (Inderal) Ranolazine Ivabradine (Coralan)
Nitro 5) Amlodipine (Norvasc) Metoprolol (Betaloc, Neobloc) Trimetazidine (Vastarel)
Prototype Felodipine (Dilahex, Felim, Plendil ER, Atenolol (Durabeta, Tenormin,
SL, spray, transdermal patch, oral, IV Versant-XR) Therabloc)
infusion Nicardipine (Cardepine) Esmolol (Brevibloc)
Isradipine Bisoprolol (Concore)
Isosorbide dinitrate (Isoket, Isordil) Nisoldipine Betaxolol (Kerlone)
Isosorbide mononitrate (Elantan, Nitrendipine Pindolol
Imdur Durules) Bepridil Acebutolol
SL, oral Timolol
Diltiazem (Angiozem, Dilzem, Zandil) Nadolol
Pentaerythritol tetranitrate Benzothiazepine Labetalol
SL
Verapamil (Isoptin)
Erythritol tetranitrate Phenylalkylamine
SL, oral

1
 AGENTS USED IN CARDIAC ARRHYTHMIAS
Class I Class II Class III Class IV
Miscellaneous
Na+ channel blockade β-blockers Prolong action potential Ca++ channel blocking agent
Class Ia Class Ib Class Ic Propranolol Amiodarone (Cordarone) Verapamil Adenosine
Procainamide Lidocaine Flecainide Esmolol PO, IV Indicated for supraventricular DOC for the conversion of
2nd DOC next to DOC for ventricular Potent blocker of K+ Sotalol May cause hypo or tachycardia (SVT) paroxysmal SVT but has a very
lidocaine tachycardia channel hyperthyroidism d/t I2 S/E: constipation, peripheral short duration of action
May cause Least cardiotoxic of all edema Inhibits AV nodal conduction
hypotension (IV) Na+ channel blockers Propafenone Dronedarone Given in bolus dose of 6 mg
Depressant action on given thru IV route Moricizine Analog of amiodarone without Diltiazem followed by 12 mg
SA and AV nodes S/E: neurologics I2
May cause torsade de (paresthesias, tremor, Magnesium
pointes (Tdp) nausea, hearing Bretylium Indicated for Tdp
Long term use may disturbance, slurred 1st introduced for its anti- Usual dose is 1 g (as sulfate) IV
lead to SLE-like speech and convulsion) hypertensive effect over 20 minutes
syndrome Indicated also for digitalis
Mexiletine Sotalol induced arrhythmias if
Quinidine Orally active congener Dofetilide hypomagnesemia is present
PO of lidocaine Ibutilide
Tx of malaria Used for ventricular Potassium
May cause cinchonism arrhythmia KCl
(HA, dizziness, tinnitus) “Crowning effect” when given
Phenytoin as IV infusion
Disopyramide Indicated for digitalis Not given as injection d/t
PO induced arrhythmia extravasation
C/I: Px with heart
failure, glaucoma and
BPH
Atropine like activity

2
 DRUGS USED FOR THE MANAGEMENT OF HEART FAILURE
contractility: inotropics
resistance: vasodilators
fluid retention: diuretics
(+) Inotropics Vasodilators Diuretics β-blockers ACE Inhibitors
force of contraction PR Na, H2O retention  aldosterone salt and water
retention
Digoxin (Lanoxin, Inoxin) Nitroprusside Thiazide diuretics Bisoprolol -pril
Glycoside from white foxglove (Digitalis Hydralazine Metoprolol
lanata) Prazosin Loop diuretics
Inhibits Na-K ATPase pump Na  Na- Nitrates Furosemide – used for pulmonary Carvedilol
Ca exchanger Ca edema Management of chronic HF
Low therapeutic index Nesiritide Initiate with low doses, titrate upward
Dose adjustment is needed for px with Recombinant form of human B-type Potassium sparing diuretics slowly
renal impairment natriuretic peptide Co-administered with digoxin
S/E: digitalis toxicity (esp. if hypoK and Bids to natriuretic peptide receptors in
hyperCa  digitalis induced arrhythmia BV CGMP in target tissues
Tx: gastric lavage (6-8 hours) pulmonary capillary wedge and
Lidocaine or phenytoin systemic vascular resistance
Cholestyramine – break enterohepatic
circulation
Digoxin-specific Fab fragment
antibodies – binds to digoxin 
complex is excreted renally

Inamrinone previously called

Amrinone, Milrinone
Inhibits phosphodiesterase cAMP Ca
(+) inotropic
Inodilator, vasodilator CO
S/E: hypotension, arrhythmia,
thrombocytopenia

Dopamine
β1 agonist
2-5 mcg/kg/min – renal D1 receptor
5-10 mcg/kg/min - β1 receptor
>10 mcg/kg/min - α1 agonist

Dobutamine

3
β1 and β2 agonist with some α1 agonist
effect  less tachycardia