ANGINA-DRUGS

SUMMARY

1. Beta-blockers, nitrates are the staple of treatment; CCB also help by coronary & peripheral vasodilation, decreasing myocardial O₂ demand & afterload.
2. Nitrates: decrease preload more than afterload & dilate coronary vessels, can cause severe decompensation in patients with an acute right ventricular MI (hence, avoid). Patients on nitrates get a sympathetic reflex increase in HR.

3. Beta-blockers: decrease myocardial O₂ demand by decreasing HR, BP, & contractility. Beta-blockers complement nitrates well because they decrease the reflex tachycardia.

4. CCB: Nifedipine and amlodipine decrease angina by coronary artery vasodilation & peripheral vasodilation (decreases workload).

5. Anti-anginal effect of diltiazem and verapamil is due to their negative chronotropic effect. Should be used cautiously in patients with systolic heart failure due to the negative inotropic effects.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].