ANTIANGINAL AGENTS - Antianginal agents is a term used to describe a wide variety of medicines that

are used in the management of angina. Angina is a heart condition characterized by a narrowing of the
coronary arteries (the arteries of the heart). Chest pain is its main symptom.

Common Antianginal Drugs

NITRATES
DRUG NAME nitroglycerin (e.g., Nitrolingual, Nitro-Bid, Nitro-Dur, NitroMist);
isosorbide dinitrate; isosorbide mononitrate

CLASS Nitrates

MECHANISM OF ACTION Relax vascular smooth muscle cells, thereby causing venous and
arterial vasodilation; decrease both preload and afterload; relax
coronary arteries

INDICATIONS Angina pectoris, hypertension, heart failure, anal fissure

ROUTE/S OF Nitroglycerin
ADMINISTRATION
 S/L
 PO, PO spray
 IV
 Transdermal patch
 Topical ointment
 PR

Isosorbide dinitrate, isosorbide mononitrate

 PO

SIDE EFFECTS Headache, dizziness, flushing, nausea and vomiting, orthostatic

hypotension, reflex tachycardia, tolerance

CONTRAINDICATIONS AND  Hypotension, hypovolemia, severe anemia, cardiomyopathy

CAUTIONS  Use carefully during pregnancy, breastfeeding, children or
elderly, increased intracranial pressure, cerebral
hemorrhage, renal or hepatic disease, and syncope
 Drug interactions: other vasodilators (i.e., alcohol or erectile
dysfunction medication like sildenafil, tadalafil, or vardenafil)
CALCIUM ANTAGONIST
DRUG NAME Dihydropyridines: nifedipine (Procardia, Adalat), amlodipine
(Norvasc), clevidipine (Cleviprex), nicardipine (Cardene), felodipine
(Plendil), nimodipine (Nimotop)

Non-dihydropyridines: diltiazem (Cardizem), verapamil (Calan,

Isoptin)
CLASS Calcium Channel Blockers (CCB
MECHANISM OF ACTION  Block the entry of calcium into the cells
 Reduce the contraction of vascular smooth muscle and
cardiac muscle
o Dilate arterioles, and reduce blood pressure and
peripheral vascular resistance
o Dilate coronary vessels and increase oxygen supply
to the heart
o Reduce force of contraction of cardiac muscles and
reduce oxygen demand of the heart
 Reduce the firing and conduction of impulse through the SA
and AV nodes in the heart

INDICATIONS  Cardiac arrhythmia, hypertension, angina pectoris, tocolysis

in preterm labor, Raynaud’s phenomenon, migraine
prophylaxis
 Nimodipine: subarachnoid hemorrhage

ROUTE/S OF  PO
ADMINISTRATION  IV

SIDE EFFECTS  General: headache, dizziness, flushing of the skin, peripheral

edema, hypotension
 Dihydropyridines: reflex tachycardia, gingival hyperplasia
 Non-dihydropyridines: bradycardia, constipation and
hyperprolactinemia

CONTRAINDICATIONS AND  Pre-existing bradycardia

CAUTIONS  Heart block
 Heart failure
 Use with caution: hepatic and renal disease
 Interactions: digoxin, grapefruit
BETA-BLOCKERS
DRUG NAME nadolol (Corgard), propranolol
(Inderal, InnoPran XL), pindolol
(Visken), sotalol (Betapace,
Sorine)
atenolol (Tenormin), metoprolol
(Lopressor, Toprol XL),
carvedilol (Coreg), nebivolol
(Bystolic)

CLASS Nonselective β-blockers Selective β-blockers

MECHANISM OF ACTION The medicines block the effects of the hormone epinephrine, also
known as adrenaline that causes the heart to beat more slowly and
with less force. This lowers blood pressure helping the veins to widen
and arteries to improve blood flow.

INDICATIONS  Hypertension
 Coronary artery disease; angina pectoris, myocardial
infarction
 Arrhythmias
 Heart failure
 Essential tremor
 Glaucoma
 Migraine prophylaxis

ROUTE/S OF  PO
ADMINISTRATION  IV
 Ophthalmic

SIDE EFFECTS  Bradycardia

 Hypotension
 Fatigue
 Dizziness
 Bronchospasm and dyspnea
 Headache
 Hyperkalemia
 Hyperglycemia

CONTRAINDICATIONS AND  Bradycardia

CAUTIONS  Hypotension
 Second or third degree AV block
 Asthma
 COPD
 Diabetes
 Raynaud phenomenon