Angina pectoris receptor antagonists

Because of these interindividual variations in the kinetics of propranolol, the therapeutic dose of this drug is best determined by titration. End points of titration include relief of anginal symptoms, increases in exercise tolerance, and plasma concentration of propranolol between 15 and 100 ng/mL. For additional details on the pharmacokinetics of propranolol and other (3-receptor antagonists approved for clinical use in the treatment of angina pectoris, see Table 17.3 and Chapter 11. 

Beta antagonists are generally administered for their effect on the beta-1 receptors that are located on the heart.31 When stimulated, these receptors mediate an increase in cardiac contractility and rate of contraction. By blocking these receptors, beta antagonists reduce the rate and force of myocardial contractions. Consequently, beta antagonists are frequently used to decrease cardiac workload in conditions such as hypertension and certain types of angina pectoris. Beta blockers may also be used to normalize heart rate in certain forms of cardiac arrhythmias. Specific clinical applications of individual beta blockers are summarized in Table 20-2. 

Alpha-adrenergic antagonists are used primarily as antihypertensive drugs because of their ability to block vascular alpha-1 receptors. Beta-adrenergic antagonists (beta blockers) are administered primarily for their inhibitory effects on myocardial function and are used in the prevention and treatment of hypertension, angina pectoris, arrhythmias, and myocardial reinfarction. Many of the drugs introduced in this chapter are discussed further in chapters that deal with the specific clinical conditions (e.g., hypertension, asthma, and other disorders). 

Trade names Apo-Nadolol Corgard Corzide (Monarch) Farmagard Nadic Solgol Syn-Nadolol Indications Hypertension, angina pectoris Category Adrenergic beta-receptor antagonist Antiarrhythmic class II... 

Task forces from the ACC and the AHA have published guidelines that are useful in the selection of appropriate initial therapy for patients with chronic stable angina pectoris (www.americanheart.org). Patients with coronary artery disease should be treated with aspirin and a P adrenergic receptor antagonist (particularly if there is a history of prior MI). The guidelines also... 

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