Cardiovascular Medications: Section 1

best drugs for treating coronary artery disease; acute and chronic anginal attacks

• Nitrate prodcuts directly cause vascular smooth muscle to relax in arterial and venous circulation.
• It decreases the myocardial O₂ use.
• It increases collateral-vessel circulation to the heart.

• Flushing
• headache
• postural hypotension
• dizziness
• tachycardia
• weakness
• vertigo

Tolerance to nitrates may develop over time with repeated use. If the patient develops tolerance to one nitrate, it is likely that tolerance to other nitrates (Cross-tolerance) will develop. Alternative coronary vasodilators may have to be used.

• classification: Antianginal
• trade name: Dilatrate Sr, Titradose
• uses: Prophylaxis of angina; acute angina
• Adverse reaction: flushing, headache, dizziness, tachycardia, weakness, vertigo
• dose ranges: 5-30 mg PO 2-3 times daily; 2.5-30 mg SL; 5mg chewable; increase as needed

• classifiaction: Antianginal
• trade name: Ismo, Imdur
• uses: prophylaxis of angina
• adverse reaction: flushing, headache, dizziness, tachycardia, wekaness, vertigo
• dose ranges: 20 mg PO twice daily

• classifiaction: Antianginal
• trade name: Nitrostat, NitroQuick
• uses: prophylaxis of angina, treatment, and management of angina
• adverse reaction: flushing, headache, dizziness, tachycardia, wekaness, vertigo
• dose ranges: 1 tab SL; repeat in 5 min 3 times as needed

• classification: Antianginal
• trade name: Nitro-Time
• uses: prophylaxis or management of angina
• adverse reaction: flushing, headache, dizziness, tachycardia, wekaness, vertigo
• dose ranges: 1 cap or tab every 8-12h

• classification: Antianginal
• trade name: Nitro-Bid
• uses: prevention and treatment of angina caused by CAD
• adverse reaction: flushing, headache, dizziness, tachycardia, wekaness, vertigo
• dose ranges: 1-2 inches every 5-8h (1 inch = 15 mg NTG)

• classification: Antianginal
• trade name: MiniTran, Nitro-Dur
• uses: Prevention and treatment of angina caused by CAD
• adverse reaction: flushing, headache, dizziness, tachycardia, wekaness, vertigo
• dose ranges: apply pad daily; leave on for 12-14 hr; take off for 10-12hr

• classification: Antianginal
• trade name: Nitrolingual Pump spray
• uses: prophylaxis and treatment of acute angina
• adverse effects: flushing, headache, dizziness, tachycardia, weakness, vertigo
• dose ranges: 1 oe 2 metered doses sprated onto oral mucosa or under tongue

• 1. very fragile & chemically breaks down rapidly; sunligh speeds up this process
• 2. drugs lose their strengths 3 montsh after the bottle has been opened.
• 3. Medication that is still active will produce a throbbing headache.
• 4. If patients fails to feel the throbbing headache, usually the medication has lost its potency (strength)

• active ingredient in NTG is easily destroyed:
• storage in plastic or in a cardboard box allows the nitrate to escape.
• placing cotton in the top of the container or storing other drugs with NTG (ex. pillbox) will absorb the ntirate.
• NTG should be stored in the original dark glass container.
• All cotton should be removed
• container should be kept tightly capped and out of sunlight
• store NTG in the refrigerator.

• should be taken on an empty stomach
• common side effects
• headache usually lasts no longer than 20 minutes and may be relieved with analgesics
• Patient should rest for 10-15 mins after the pain is relieved.
• Notify physician if blurred vision, persistent headache, or dry mouth occurs.
• If tolerance occurs, stop drug for several days then take the smallest dose to reduce the risk od tolerance
• patient should record every anginal attack, number of pills taken, and any side effects. Patient should bring this record to each visit to the health care provider.
• Keep medications out of reach of children or others.
• In hospital, BP should be taken before administering NTG