Calcium channel antagonist nitrates

If /1-blockers are ineffective or not tolerated, then monotherapy with a calcium channel antagonist or combination therapy may be instituted. Reflex tachycardia from nitrates can be blunted with /1-blocker therapy, making this a useful combination. Patients with severe angina, rest angina,... 

Because calcium channel antagonists may be more effective, have few serious adverse effects, and can be given less frequently than nitrates, some authorities consider them the agents of choice for variant angina. Nifedipine, verapamil, and diltiazem are all equally effective as single agents for... 

Monitoring for major adverse effects should be undertaken they include headache and dizziness with nitrates fatigue and lassitude with /J-blockers and peripheral edema, constipation, and dizziness with calcium channel antagonists. 

Nitrate therapy may be used to terminate an acute anginal attack, to prevent effort- or stress-induced attacks, or for long-term prophylaxis, usually in combination with j3-blockers or calcium channel antagonists. Suhhngual, huccal, or spray nitroglycerin products are preferred for alleviation of anginal attacks because of rapid absorption (Table 11-1). Symptoms may be prevented by prophylactic oral or transdermal products (usually in combination with j3-blockers or calcirun channel antagonists), but development of tolerance may be problematic. 

In the event of prolonged chest pain and ischemic ECG changes unrelieved by nitrate therapy or calcium channel antagonists, one may assume total occlusion of a coronary vessel, and steps should be taken to restore blood flow with either PCI or CABG. 

Calcium channel antagonists and nitrates also may increase myocardial oxygen supply through coronary vasodilation. Diastolic function also may be improved with verapamil, nifedipine, and perhaps, diltiazem. These effects may vary from those indicated in the table depending on individual patient baseline hemodynamics. 

The drug strategies are to increase oxygen supply by decreasing vasospasm (nitrates and calcium channel antagonists [CCBs]) and to decrease cardiac oxygen requirements by decreasing peripheral vascular resistance and/or cardiac output (nitrates, CCBs, and beta blockers). 

Patients with asymptomatic left ventricular systolic dysfunction and hypertension should be treated with P-blockers and ACE inhibitors. Those with heart failure secondary to left ventricular dysfunction and hypertension should be treated with drugs proven to also reduce the morbidity and mortality of heart failure, including P-blockers, ACE inhibitors, ARBs, aldosterone antagonists, and diuretics for symptom control as well as antihypertensive effect. In African-Americans with heart failure and left ventricular systolic dysfunction, combination therapy with nitrates and hydralazine not only affords a morbidity and mortality benefit, but may also be useful as antihypertensive therapy if needed.66 The dihydropyridine calcium channel blockers amlodipine or felodipine may also be used in patients with heart failure and left ventricular systolic dysfunction for uncontrolled blood pressure, although they have no effect on heart failure morbidity and mortality in these patients.49 For patients with heart failure and preserved ejection fraction, antihypertensive therapies that should be considered include P-blockers, ACE inhibitors, ARBs, calcium channel blockers (including nondihydropyridine agents), diuretics, and others as needed to control blood pressure.2,49... 

Systemic heat Large whirlpool Hubbard tank Decreased muscle/joint stiffness in large areas of the body Opioid and nonopioid analgesics skeletal muscle relaxants Severe hypotension may occur if systemic hot whirlpool is administered to patients taking peripheral vasodilators and some antihypertensive drugs (eg., alpha-1 antagonists, nitrates, direct-acting vasodilators, calcium channel blockers)... 

The pharmacological treatment options for ACS include agents that either reduce oxygen demand (beta blockers) or increase oxygen supply (nitrates, potassium channel activators, calcium channel blockers) to the heart and antiplatelet (aspirin, ADP-receptor antagonists, GPIIb/llla receptor blockers) and antithrombin therapy (unfractionated heparin, low molecular weight heparin, direct thrombin inhibitors) (10). 

Unstable angma.The chance of myocardial infarction is high and aspirin should be used with other drugs, i.c. a [i-adrcnoceptor antagonist,a nitrate.a calcium channel blocker and possibly heparin i.v. as is judged appropriate. 

British Columbia (Canada), under its Pharmacare programme, introduced reference pricing in five drug classes only, chosen primarily because of the level of expenditure which they represent in the drug budget NSAIDs, histamine-2 receptor antagonists, oral nitrate, ACE inhibitors and dihydropyridine calcium-channel blockers (BC Pharmacy Association). 

Calcium-channel blockers ACE inhibitors Alpha blockers Angiotensin II receptor antagonists Beta blockers + Dihydropyridines Beta blockers + Diltiazem Beta blockers + Verapamil Calcium-channel blockers Diuretics Glyceryl trinitrate (Nitroglycerin) Nitrates... 

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