Antianginal/Vasodilating

1. Nitrates
Act by relaxing smooth muscle layer of blood vessels, increasing the lumen of the
artery/arteriole, increasing the amount of blood flowing through the vessels

Organic nitrates

Isosorbide

Adverse effects: dizziness, weakness, syncope, N/V

No PDE-5 inhibitors w/isosorbide [tadalafil, vardenafil, sildebafil]

Nitroglycerin

Relaxes vascular smooth muscle, dilates arterial/venous vessels;

dilation=lowered BP

Sit and place sublingual tablet under tongue/buccal pouch, do not

chew/swallowed until properly dissolved, repeat @ 5-10min intervals x3 max,
emergency help after first tablet if angina not relieved

Adverse effects: tachycardia

Nitrates C/I in severe anemia, closed-angle glaucoma, postural hypotension, early

MI(sublingual form), head trauma, cerebral hemorrhage, constrictive pericarditis. Pt taking
phosphodiesterase inhibitors (for erectile dysfunction) should not use nitrates

PO nitrates should be taken on empty stomach, nitrates mixed w/alcohol can cause
severe hypotension

2. Calcium Channel Blockers

Have several effects on the heart: slow the conduction velocity of the cardiac impulse, depress
myocardial contractility, dilate coronary arteries/arterioles, results in delivering more oxygen to
cardiac muscle

Verapamil(Calan, Verelan)

Frequently causes GI upset, take w/meals. Tablets can be openend and sprinkled onto
food/mixed in liquids

Amlodipine(Norvasc)

For prinzmental’s angina, for chronic angina

Ditiazem(Cardizem)

Nicardipine(Cardene)
 Nifedipine(Procardia)

Monitor for peripheral edema as an adverse effect, for chronic angina

3. Pulmonary arterial hypertensive agents

Ambrisentan(Letairis)

Bosentan(Tracleer)

Macitentan(Opsumit)

Riociguat(Adempas)

Epoprostenol(Flolan, Veletri)

Iloprost(Ventavis)

Treprostinil(Remodulin,Tyvaso)

4. Vasodilating drugs(peripheral)
Minoxidil

Carefully monitor pt when giving this drug, increases the heart rate. Can cause
gynecomastia in male pt.

Hydralazine

Nitroprusside(Nitropress)

5. Miscellaneous antianginal
Ivabradine(Corlanor)

Ranolazine(Ranexa)

Do not use w/ HIV medications; can increase ranolazine levels

Nimodipine