Drugs Used in Chronic Ischemic Heart Disease

Question 1

What types of drugs are used in chronic IHD?

Answer 1

1. Nitrates (nitrovasodilators)
2. Calcium channel blockers
3. Beta-blockers

Question 2

List of Nitrates (nitrovasodilators)

Answer 2

– Nitroglycerin (generic, Nitro-Dur, Nitro-Time)

– Isosorbide dinitrate (Isordil)

– Isosorbide mononitrate (Ismo)

Question 3

List of Calcium channel blockers: Non-cardioactive (dihydropyridines)

Answer 3

• Amlodipine (Norvasc)
• Nifedipine (Adalat)
• Nicardipine (Cardene)

Question 4

List of Calcium channel blockers: Cardioactive

Answer 4

• Diltiazem (Cardizem)

* Verapamil (Isoptin)

Question 5

List of Beta-Blockers

Answer 5

– Propranolol (Inderal)
– Nadolol (Corgard)
– Metoprolol (Toprol)
– Atenolol (Tenormin)

Question 6

What is the clinical use of Nitrates?

Answer 6

• Short-acting formulations are used to relieve the angina attack
• Long-acting preparations may be used to PREVENT attacks

Question 7

What are some adverse effects of Nitrates?

Answer 7

• Headache (due to meningeal vasodilation; nitrates are contraindicated if intracranial
pressure is elevated)

• Orthostatic hypotension

• Increased sympathetic discharge
– Tachycardia
– Increased cardiac contractility

• Increased renal Na+ and H2O reabsorption

Question 8

What are some adverse effects to calcium channel blockers?

Answer 8

• Major:
– Cardiac depression, cardiac arrest, and acute
heart failure (cardioactive CCBs) – Bradyarrhythmias, atrioventricular block
(cardioactive CCBs)
– Short acting dihydropyridine CCBs – vasodilation
triggers reflex sympathetic activation
– Nifedipine (immediate release) increases the risk of MI in patients with hypertension – slow-release
and long-acting dihydropyridines are better
tolerated

• Minor
– Flushing, headache, anorexia, dizziness
– Peripheral edema
– Constipation 30

Question 9

What are some adverse effects of Beta-blockers?

Answer 9

– Reduced cardiac output
– Bronchoconstriction
– Impaired liver glucose mobilization
– Produce an unfavorable blood lipoprotein profile
(increase VLDL and decrease HDL)
– Sedation, depression
– Withdrawal syndrome associated with sympathetic hyperresponsiveness

Question 10

What are some contraindications for Beta-Blockers?

Answer 10

– Asthma
– Peripheral vascular disease
– Type 1 diabetics on insulin
– Bradyarrhythmias and AV conduction abnormalities 
– Severe depression of cardiac function