Nifedipine Nitroglycerin

A treatment of angina that consistently decreases the heart rate and can prevent vasospastic angina attacks is (A) Isosorbide dinitrate Nifedipine Nitroglycerin Propranolol Verapamil... 

Drugs for the control of hypertensive crises include nifedipine (capsule, to be chewed and swallowed), nitroglycerin (sublingually), clonidine (p.o. or i.v., p. 96), dihydralazine (i.v.), diazoxide (i.v.), fenoldopam (by infusion, p. 114) and sodium nitroprusside (p. 120, by infusion). The nonselective a-blocker phentolamine (p. 90) is indicated only in pheochromocytoma... 

The main drngs nsed for myocardial ischema therapy and for relieving pain in angina pectoris are nitrates and nitrites (nitroglycerin, isosorbide dinitrate, and pentaerythritol tetranitrate) snbstances that snppress adrenergic systems of the heart—j3-adrenoblockers (atenolol, methoprolol, propranolol, and nadolol), and Ca + channel blockers (verapamil, diltiazem, nifedipine, and nicardipine) as well as a few older drugs, in particular papaverine and dipyridamole. 

The sublingual surface area is relatively small but has a rich blood supply. The major advantage of this route is avoidance of intestinal destruction and hepatic first pass metabolism. However, absorption can be highly variable critical factors are the residence time of the drug in the mouth and saliva flow. Premature swallowing or excessive saliva production preclude efficient absorption. Nitroglycerin, nifedipine, propranolol, and buprenorphine are all available as sublingual preparations. Rectal... 

Calcium channel blockers with vasodilator effects, such as nifedipine, nicardipine, and nimodipine, will potentiate the effect of vasodilator effects of, e.g. halothane or isoflurane, potentiating any hypotension. This is especially obvious in hypertensive patients and when combined with similarly acting agents, such as sodium nitroprusside or nitroglycerin. Similarly, they also enhance the tendency of volatile anaesthetics to reduce hypoxic pulmonary vasoconstriction, which might exacerbate ventilation/perfusion mismatching during anaesthesia. 

D Rifampin significantly reduces the plasma concentrations of the calcium channel blockers verapamil, diltiazem, and nifedipine. Diltiazem is a substrate of Gi P3A4 and rifampin is an inducer of CYP3A4. Rifampin does not interact with metoprolol, aspirin, pravastatin, or nitroglycerin. However, if the patient had been on another HMG-CoA reductase inhibitor such as atorvastatin, lova-statin, or simvastatin instead of pravastatin, rifampin would have reduced the plasma concentrations of these agents since they are also metabolized via CYP3A4. 

Boje KM, Fung H-L, Yoshitomi K, Parker JO. Haemodynamic effects of combined oral nifedipine and sublingual nitroglycerin in patients with chronic stable angina. EurJ Clin Pharmacol (1987)33, 349-54. 

Gascho JA, Apollo WP. Effects of nifedipine on the venodilatory response to nitroglycerin. Am J Cardiol (1990) 65, 99-102. 

Kubo SH, Fox SC, Prida XE, Cody RJ. Combined hemodynamic effects of nifedipine and nitroglycerin in congestive heart failure.(1985) 110, 1032-4. 

If spasm of the ovarian vein occurs during selective catheterization then forceful injection of 5 cc of normal saline followed by a wait of 4-5 min is usually sufficient to allow resolution. The use of injectable vasodilators such as nitroglycerin has not been successful in the author s hands. If resolution of spasm is not possible, the procedure can be attempted on another occasion and at that instance the patient provided with sublingual nifedipine and intravenous sedation prior to the procedure. 

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