Propranolol in angina pectoris

The therapeutic action of 3-adrenergic receptor blockers such as propranolol in angina pectoris is believed to be primarily the result of... 

FDA Approves Propranolol in Angina Pectoris, FDA Drug Bulletin. 

Families USA. Profiting from Pain Where Prescription Dollars Go. Washington, D.C. Families USA, 2002. FDA Approves Propranolol in Angina Pectoris. FDA Drug Bulletin, January 1974,1. 

Neilson GH, Seldon WA. Propranolol in angina pectoris. MedJAust (1969) 1, 856-57. 

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. 

Unlike propranolol, which blocks both and j32 dr6noreceptors, metroprolol exhibits cardioselective action, i.e. in therapeutic doses, it blocks Sj-adrenoreceptors with insignificant effects on j32-adrenoreceptors. Metroprolol is used for myocardial infarctions, for preventing cardiovascular tissue death, and in angina pectoris. The most common synonym of this drug is lopresor. 

These dm are primarily used in the treatment of hypertension (see the Summary Drug Table Adrenergic Blocking Drugs also see Chap. 39) and certain cardiac arrhythmias (abnormal rhythm of the heart), such as ventricular arrhythmias or supraventricular tachycardia They are used to prevent reinfarction in patients with a recent myocardial infarction (1—4 weeks after MI). Some of these dm have additional uses, such as the use of propranolol for migraine headaches and nadolol for angina pectoris. 

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. 

Table 17.3 and Chapter 11 provide additional details concerning the most commonly used p-blockers (i.e., propranolol, nadolol, atenolol, and metoprolol) in the treatment of angina pectoris. 

Abrupt interruption of propranolol therapy in individuals with angina pectoris has been associated with reappearance of angina, acute myocardial infarction, or death due to a sudden increase in sympathetic nervous system tone to the heart. The mechanisms underlying these reactions are unknown, but they may be the result of an increase in the number of p-receptors that occur following chronic p-adrenoceptor blockade (up-regulation of receptors). When it is advisable to discontinue propranolol administration, such as before coronary bypass surgery, the dosage should be tapered over 2 to 3 days. 

Angina pectoris Propranolol decreases O2 requirement and work of heart muscle and therefore is effective in reducing the chest pain on exertion which occurs in angina. 

Propranolol [Inderal). Propranolol, the classic nonselective beta blocker, is approved for use in hypertension, angina pectoris, cardiac arrhythmias, and prevention of myocardial reinfarction. In addition, propranolol has been used in the prevention of vascular headache and as an adjunct to alpha blockers in treating pheochromocytoma. Propranolol is usually administered orally for the long-term management of the previously listed conditions, but it may be administered via intravenous injection for the immediate control of arrhythmias. 

Beta (/3)-blockers (e.g., propranolol, atenolol, oxyprenolol, pindolol) are used for treating hypertension, cardiac arrhythmias, angina pectoris, and myocardial infarction. These drugs have proven important in the management of alcohol withdrawal and hypothyroidism.56 -blockers also are used as prophylactics in... 

Placebos are effective for a variety of conditions. Patients with angina pectoris (insufficient blood flow to the heart) responded to placebo surgery in which surgeons made only an incision in the chest. And in a study of the drug propranolol that is used after heart attacks to prevent further damage, investigators noticed that patients who took placebo pills regularly had a lower death rate than patients who took placebos sporadically. Therefore, the placebo effect is not unique to psychiatric illness. 

Landau, A. J., Frishman, W. H., Alturk, N., Adjei-Poku, M., Fornasier-Bongo, M., and Furia, S. (1993), Immediate beta-adrenergic blockade and improved exercise tolerance with intranasal propranolol in patients with angina pectoris, Am. J. Cardiol., 72, 995-998. 

Myers MG, Wisenberg G. Sudden withdrawal of propranolol in patients with angina pectoris. Chest 1977 71(l) 24-6. 

Leon MB, Rosing DR, Bonow RO, Lipson LC, Epstein SE. Clinical efficacy of verapamil alone and combined with propranolol in treating patients with chronic stable angina pectoris. Am J Cardiol 1981 48(l) 131-9. 

Propranolol is used in the treatment of arrhythmias of atrial and ventricular origin, angina pectoris, myocardial infarction, and hypertension. It is a nonselective p-blocker with action on cardiac receptors (p,) and on vascular and bronchial smooth muscle receptors ( 2) Propranolol s principal effect is to reduce the heart rate, thus relieving angina, and to slow conduction at the atrioventricular node, reducing tlie ventricular rate in patients with atrial fibrillation. It is included here as representative of other P-blockers, such as acebutalol, prindolol, esmolol, flestolol, metoprolol, nadolol, and sotalol, which are like propranolol. 

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