McKenna's Pharmacology for Nursing, 2e

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P A R T 8  Drugs acting on the cardiovascular system

TABLE 46.1

DRUGS IN FOCUS Antianginal agents

Drug name

Dosage/route

Usual indications

Nitrates

5 mcg/minute via IV infusion pump every 3–5 minutes; one tablet SL every 5 minutes for acute attack, up to three tablets in 15 minutes; 0.4-mg metered dose translingual, up to three doses in 15 minutes for acute attacks Prevention: one tablet (0.3–0.6 mg) sublingually 5–10 minutes before activities that might precipitate an attack: 2.5–9 mg PO of SR tablet q 8–12 hours; doses as high as 26 mg PO q.i.d. have been used; 1.25 cm q 8 hours for topical aplication, up to 10–12.5 cm (2.5 cm=15 mg) have been used; one pad (60–75 mg) have been used; one pad transdermal system per day; 1 mg q 3–5 hours while awake for transmucosal system 2.5–5 mg sublingual (SL); 5-mg chewable tablet; 5–20 mg PO; maintenance 10–40 mg PO q 6 hours or 40–80 mg PO sustained release q 8–12 hours Acute prophylaxis: 5–10 mg SL or chewable tablets q 2–3 hours 2.5–5 mg SL; 5-mg chewable tablet; 5–20 mg PO; maintenance 10–40 mg PO q 6 hours or 40–80 mg PO sustained release q 8–12 hours Acute prophylaxis: 5–10 mg SL or chewable tablets q 2–3 hours 100 mg/day PO as single dose, extended- release tablet; 100–400 mg/day PO in two divided doses regular release 10–20 mg PO t.d.s. to q.i.d., titrate based on response; 160 mg/day is often needed for maintenance 5 mg/day PO; reduce dose with hepatic impairment or in geriatric persons 180–360 mg/day PO in three or four divided doses; 120–180 mg PO b.d. sustained release

Nitrate of choice for treatment of acute angina attack; prevention of anginal attacks

glyceryl trinitrate (Anginine, Nitro-Dur,

Nitrolingual)

isosorbide dinitrate (Isordil, Sorbidin)

Taken before chest pain begins in situations in which exertion or stress can be anticipated for prevention of angina in adults; taken daily for management of chronic angina Taken before chest pain begins in situations in which exertion or stress can be anticipated for prevention of angina in adults; taken daily for management of angina Treatment of angina in adults; prevention of reinfarction within 3–10 days after myocardial infarction (MI) Long-term management of angina and prevention of reinfarction in people 1–4 weeks after MI

isosorbide mononitrate (Duride, Imdur)

Beta-blockers

metoprolol (Betaloc, Minax)

propranolol (Inderal)

Calcium channel blockers amlodipine (Norvasc)

Treatment of chronic, stable angina and of variant angina in adults

Treatment of angina in adults

diltiazem (Cardizem)

nifedipine (Adalat, Nyefax)

10–20 mg PO t.d.s.

Treatment of angina in adults

perhexiline (Pexsig)

Initially, 100 mg PO daily, up to 400 mg/day PO Treatment of moderate to severe angina in adults who have not responded to other treatment

verapamil (Cordilox SR, Isoptin)

320–480 mg/day PO

Treatment of angina in adults; treatment of tachyarrhythmias

Potassium channel opener nicorandil (Ikorel)

10-20 mg PO b.d.

Treatment of chronic stable angina pectoris