Antianginal agents

Question 1

Enalapril (Vasotec)

Answer 1

Class: Ace inhibitor, antihypertensive

MOA: blocks the conversion of angiotensin I to angiotensin II (vasoconstrictor), resulting in systemic vasodilation

Pharmacokinetics: Onset 15-30 min, duration 6-12 hrs; HL; 1-2 days

Indications: CHF, hypertension

AR/SE: angioedema, cough, hypotension, taste disturbance, dizziness

Contraindications: known allergy, hx of angioedema from previous Ace inhibitors

Dosage: 1.25 mg IV over 5 minutes every 6 hours

Special Considerations: (P Class C 1st trimester, D 2nd/3rd trimester)

Question 2

Captopril (Capoten)

Answer 2

Class: Ace Inhibitor, antihypertensive

MOA: blocks the conversion of angiotensin I to angiotensin II (vasoconstrictor), resulting in systemic vasodilation

Pharmacokinetics: Onset-5-6 min; duration- 2-12 hrs; HL: 2 Hrs

Indications: management of CHF, can be used in hypertensive emergencies as well

AR/SE: cough, angioedema, hypotension, taste disturbances

Contraindications: known allergy, pts with hx of angioedema from previous Ace inhibitors

Dosage: 12.5 -25 mg PO

Special Considerations: (P class c 1st trimester, D 2nd/3rd trimester)

Question 3

Nitroprusside (Nipride/Nitropress)

Answer 3

Classification: antihypertensive, vasodilator

MOA: produces peripheral vasodilation by direct action on both arteriolar and venous smooth muscle

Pharmacokinetics: absorbs completely; onset immediate; duration 1-10 minutes

Indications: hypertensive crisis, cardiac failure, control hypertension in acute stroke

AR/SE: dyspnea, dissiness, headache, abd pain, N/V

Contraindications: known allergy, pts with decreased cerebral perfussion

Dosage: 0.3 mcg/kg/min may be increase prn up to 10mcg/kg/min; not to exceed 10 min at 10 mcg/kg/min

Question 4

Hydralazine (apresoline)

Answer 4

Class: vasodilator, antihypertensive

MOA: direct-acting peripheral arteriolar vasodilator

Pharmacokinetics: Onset 5-15 min IV, Duration 2-6 hrs IV; HL: 2-8 hrs

Indications: moderate to severe hypertension, pre-eclampsia

AR/SE: tachycardia, sodium retention, edema, orthostatic hypotension, N/V/D

Contraindications: known allergy, intolerance to tartazine

Dosage: 10 mg slow IV may repeat in 4-6 hours if needed