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Nifedipine: Cardiovascular Drugs B1. Anti-Anginal Drugs
Nifedipine: Cardiovascular Drugs B1. Anti-Anginal Drugs
Nifedipine
Adalat
Capsules: 10 mg
Capsules: 20 mg
Adalat CC
Tablets, extended-release: 30 mg
Tablets, extended-release: 60 mg
Tablets, extended-release: 90 mg
Nifedical XL
Tablets, extended-release: 30 mg
Tablets, extended-release: 60 mg
Procardia
Capsules: 10 mg
Capsules: 20 mg
Procardia XL
Tablets, extended-release: 30 mg
Tablets, extended-release: 60 mg
Tablets, extended-release: 90 mg
Adalat PA
Adalat PA 10
Adalat PA 20
Adalat XL
Actions Inhibits movement of calcium ions across cell membrane in systemic and coronary vascular
smooth muscle and myocardium. Increases CO and decreases peripheral vascular resistance. Minimal
effect on sinoatrial and AV nodal conduction. Reduces myocardial oxygen demand; relaxes and prevents
coronary artery spasm.
Contraindications Sick sinus syndrome; second- or third-degree AV block, except with functioning
pacemaker.
Route/Dosage
Capsules: ADULTS: PO 10 mg tid (usual dose range, 10 to 20 mg tid); swallow whole. Some patients
(eg, coronary artery spasm) respond only to higher doses administered more frequently (eg, 20 to 30 mg
tid to qid; max 180 mg/day). In hospitalized patients, under close observation, dose may be increased in
10 mg increments throughout 4- to 6-hr periods as required to control pain and arrhythmias caused by
ischemia. A single dose rarely exceeds 30 mg. Extended-release tablets: ADULTS: PO Procardia XL
and Nifedical XL: 30 or 60 mg once daily, titrated over 7- to 14-day period (max, 120 mg/day). Adalat
CC (hypertension): Start with 30 mg/day and titrate dose over 7- to 14-day period (max, 90 mg/day).
Amlodipine
Norvasc
Class: Calcium channel blocker
Action Inhibits movement of calcium ions across cell membrane in systemic and coronary vascular
smooth muscle.
Contraindications Sick sinus syndrome; second- or third-degree atrioventricular (AV) block, except
with a functioning pacemaker.
Route/Dosage
Acebutolol HCl
Action Blocks beta-receptors, primarily affecting heart (slows rate), vascular musculature (decreases
BP) and lungs (reduces function).
Route/Dosage
Hypertension
ADULTS: PO 400 mg qd initially in single or divided doses; usual response range is 200 to 1200
mg/day. ELDERLY PATIENTS: May require lower maintenance doses. Do not exceed 800 mg qd.
Ventricular Arrhythmia
ADULTS: PO 400 mg (200 mg bid); may be titrated up to 1200 mg qd.
Atenolol
Action Blocks beta receptors, primarily affecting heart (slows rate), vascular system (decreases BP) and,
to lesser extent, lungs (reduces function).
Indications Treatment of hypertension (used alone or in combination with other drugs), angina pectoris
resulting from coronary atherosclerosis, acute MI. Unlabeled use(s): Migraine prophylaxis, alcohol
withdrawal syndrome, ventricular arrhythmias, supraventricular arrhythmias or tachycardias, esophageal
varices rebleeding, anxiety.
Route/Dosage
Hypertension
Angina Pectoris
Acute MIIV 5 mg over 5 min; second IV Follow with dose 10 min later. PO 50 to 100 mg/day.
Betaxolol HCl
Betoptic, Betoptic S
Class: Beta-adrenergic blocker
Action Blocks beta receptors, primarily affecting cardiovascular system (decreases heart rate, cardiac
contractility and BP) and lungs (promotes bronchospasm). Ophthalmic use reduces intraocular pressure,
probably by reducing aqueous production.
Indications Hypertension. Ophthalmic preparation: Lowering IOP; ocular hypertension; chronic open-
angle glaucoma.
Hypertension
Glaucoma
Adults: Ophthalmic 1 to 2 drops bid in affected eye(s). Consider concomitant therapy if IOP is not at
satisfactory level.
Metoprolol
Lopressor
Class: Beta-adrenergic blocker
Action Blocks beta receptors, primarily affecting cardiovascular system (decreases heart rate, decreases
contractility, decreases BP) and lungs (promotes bronchospasm).
Indications Used alone or in combination with other antihypertensive agents, for management of
hypertension, long-term management of angina pectoris, myocardial infarction (immediate-release
tablets and injection).
Contraindications Greater than first-degree heart block; congestive heart failure unless secondary to
tachyarrhythmia treatable with beta-blockers; overt or moderate to severe cardiac failure; sinus
bradycardia; cardiogenic shock; hypersensitivity to beta-blockers; systolic blood pressure < 100 mm/Hg;
MI in patients with heart rate < 45 beats/min.
Route/Dosage
Hypertension
ADULTS: PO 100 mg/day in single or divided doses initially; maintenance: 100–450 mg/day.
Angina
Myocardial Infarction
ADULTS: IV bolus injection 5 mg slowly; may repeat every 2 min up to total of 15 mg. If tolerated,
give PO 50 mg q 6 hr beginning 15 min after last IV dose; continue for 48 hr followed by PO 100 mg
bid for 1–3 mo. If patient is intolerant of full IV dose, give PO 25–50 mg q 6 hr starting 15 min after last
IV dose.
Nadolol
Corgard, Alti-Nadolol, Apo-Nadol, Novo-Nadolol
Class: Beta-adrenergic blocker
Action Blocks beta-receptors, which primarily affect cardiovascular system (decreases heart rate,
contractility and BP) and lungs (promotes bronchospasm).
Contraindications Hypersensitivity to beta blockers; greater than first-degree heart block; CHF unless
secondary to tachyarrhythmia treatable with beta-blockers or untreated hypotension; overt cardiac
failure; sinus bradycardia; cardiogenic shock; bronchial asthma or bronchospasm, including severe
COPD.
Route/Dosage
Hypertension
Angina
Pindolol
Action Nonselectively blocks beta receptors, which primarily affect heart (slows rate), vascular
musculature (decreases blood pressure) and lungs (reduces function).
Contraindications Greater than first-degree heart block; CHF unless secondary to tachyarrhythmia
treatable with beta-blockers; overt cardiac failure; sinus bradycardia; cardiogenic shock; hypersensitivity
to beta-blockers; bronchial asthma or bronchospasm, including severe COPD.
Route/Dosage
Betachron E-R, Inderal, Inderal LA, Propranolol Intensol, APO-Propranolol, Detensol, Detensol,
Dom-Propranolol, Novo-Pranol, Nu-Propranolol, PMS-Propranolol
Class: Beta-adrenergic blocker
Action Blocks beta receptors, primarily affecting the cardiovascular system (decreased heartrate,
decreased cardiac contractility and decreased BP) and lungs (promotes bronchospasm).
Contraindications Hypersensitivity to beta-blockers; greater than first-degree heart block; CHF unless
secondary to tachyarrhythmia or untreated hypertension treatable with beta-blockers; overt cardiac
failure; sinus bradycardia; cardiogenic shock; untreated bronchial asthma or bronchospasm, including
severe COPD.
Route/Dosage
Hypertension
Angina
Arrhythmias
MI
Pheochromocytoma
ADULTS: PO 60 mg/day for 3 days prior to surgery, given with alpha-blocker.
Migraine
ADULTS: PO 80 mg in divided doses daily or once daily (sustained release); titrate to response
(maximum dose: 240 mg/day); discontinue after 6 wk if no response.
ADULTS: IV 1 to 3 mg at rate of 1 mg/min; may repeat after 2 min; give subsequent doses q 4 hr.
Essential Tremor
Nitroglycerin
Deponit, Minitran, Nitrek, Nitro-Bid, Nitro-Bid IV, Nitro-Dur, Nitro-Time, Nitrodisc, Nitrogard,
Indications Treatment of acute angina (SL, translingual, IV, transmucosal); prophylaxis of angina (SL,
transmucosal, translingual, sustained release, transdermal, topical); control of blood pressure in
perioperative or intraoperative hypertension (IV); CHF associated with MI (IV). unlabeled use(s):
Reduce cardiac workload in patients with MI and in refractory CHF (SL, topical, oral, IV); adjunctive
treatment of Raynaud's disease (topical); treatment of hypertensive crisis (IV).
Route/Dosage
Perioperative Hypertension
ADULTS IV 5 mcg/min using nonperipheral vein catheter (PVCP) IV administration set initially; titrate
to response.
Angina
ADULTS SL 0.15 to 0.6 mg dissolved under tongue or in buccal pouch at first sign of acute angina
attack; repeat q 5 min (do not exceed 3 tablets in 15 min). Translingual 1 to 2 sprays onto or under
tongue at first onset of attack. Transmucosal 1 mg every 3 to 5 hr during waking hours; tablet placed
between lip or cheek and gum. PO 2.5 or 2.6 mg (sustained-release form) tid to qid initially; titrate to
response. Transdermal 0.2 to 0.4 mg/hr patch initially applied once daily; titrate dose to response.
Topical 1 to 2 inches q 8 hr up to 4 to 5 inches spread over 3 x 4 inch area and cover with plastic wrap
to prevent staining of clothes or application q 4 hr prn. Allow a nitrate-free period of 10 to 12 hr/day.
Adults IV 5 mcg/min initially; titrate according to hemodynamic readings (BP, heart rate, pulmonary
capillary wedge pressure).
Isosorbide Mononitrate
Route/Dosage
ADULTS: PO 20 mg bid, given 7 hr apart. Extended release tablets are given as 30 (½ of 60 mg tablet)
or 60 mg once daily. After several days dosage may be increased to 120 mg (given as two 60 mg tablets)
once daily. Rarely, 240 mg may be required.
Isosorbide Dinitrate
Route/Dosage
Angina Pectoris
ADULTS: SL (sublingual tablets) 2.5 to 5 mg; PO (chewable tablets) 5 mg; PO (oral tablets) 5 to 40 mg
q 6 hr; PO (sustained release tablets) 40 to 80 mg q 8 to 12 hr.
Acute Prophylaxis
ADRENERGIC
Dobutamine
Dobutrex
Class: Vasopressor
Action Stimulates beta1-receptors in heart, causing more complete and forceful contractions (inotropy)
without significantly increasing heart rate or BP.
Indications Treatment of cardiac decompensation caused by organic heart disease or cardiac surgical
procedures. Unlabeled use(s): Congenital heart disease in children undergoing diagnostic cardiac
catheterization.
Route/Dosage
ADULTS: IV infusion 2.5 to 10 mcg/kg/min; titrate to desired response; increase in heart rate > 10%
may develop in rate > 20 mcg/kg/min; rates up to 40 mcg/kg/min are rarely used. Duration of therapy up
to 72 hr without decrease in clinical effectiveness may be used.
Dopamine HCl
Intropin, Revimine
Class: Vasopressor
Action Stimulates beta1 receptors in heart, causing more complete and forceful contractions (inotropy).
Also acts on alpha receptors (dose dependent) and has dopaminergic effects.
Route/Dosage
Epinephrine
Adrenalin Chloride
Solution: 0.1%, 1 mg/mL as HCl
Ana-Kit
AsthmaNefrin
Solution for inhalation: 2.25% racepinephrine HCl (1.125% epinephrine base)
Epifrin
Solution: 0.5%, 1%, 2%
Epinal
Solution: 0.5%, 1%
Epipen
Solution: 1 mg/mL as HCl
Epipen Jr.
Solution: 1 mg/mL as HCl
Glaucon
Solution: 1%, 2%
MicroNefrin
Solution for inhalation: 2.25% racepinephrine HCl (1.125% epinephrine base)
Nephron
Solution for inhalation: 2.25% racepinephrine HCl (1.125% epinephrine base)
Primatene Mist
Aerosol: 0.2 mg epinephrine per spray
S-2
Solution for inhalation: 2.25% racepinephrine HCl (1.125% epinephrine base)
Sus-Phrine
Suspension for injection: 5 mg/mL
Bronkaid Mistometer
Epi E•Z Pen Jr
Class: Vasopressor
Actions Stimulates both alpha-and beta-receptors (alpha-receptors at high doses; beta1 - and beta2
-receptors at moderate doses) within sympathetic nervous system. Relaxes smooth muscle of bronchi
and iris and is antagonist of histamine.
Indications Treatment and prophylaxis of cardiac arrest and attacks of transitory atrioventricular heart
block; treatment of Adams-Stokes syndrome; treatment of hay fever; relief of bronchial asthma;
treatment of syncope caused by heart block or carotid sinus hypersensitivity; symptomatic relief of
serum sickness, urticaria and angioedema; relaxation of uterine musculature; anaphylaxis; allergic
reactions (eg, bronchospasm, urticaria, pruritus, angioneurotic edema, or swelling of the lips, eyelids,
tongue, and nasal mucosa) because of anaphylactic shock caused by stinging insects (primarily of the
order Hymenoptera, which includes bees, wasps, hornets, yellow jackets, bumble bees, and fire ants);
severe allergic or anaphylactoid reactions caused by allergy injections; exposures to pollens, dusts
molds, foods, drugs, and exercise or unknown substances (so-called idopathic anaphylaxis); severe, life-
threatening asthma attacks characterized by wheezing, dysypena, and inability to breathe.
Nasal Solution: Treatment of nasal congestion; relief of eustachian tube congestion. Inhalation:
Temporary relief from acute paroxysms of bronchial asthma and other states; treatment of postintubation
and infectious croup. Ophthalmic Solution: Treatment of open-angle glaucoma.
Route/Dosage
Cardiac Arrest
Other IV Uses
Intraspinal Use
ADULTS: Intraspinal 0.2 to 0.4 mL of 1:1000 solution added to anesthetic spinal fluid mixture.
Epinephrine 1:100,000 to 1:200,000 is usual concentration employed with local anesthetics.
Open-Angle Glaucoma
Nasal Congestion
ADULTS AND CHILDREN 6 yr: Nasal Apply as drops, spray, or with sterile swab as required.
Asthma
ADULTS AND CHILDREN 4 yr (Asthma Nefrin 12 yr): Inhalation Hand pump nebulizer: Place
0.5 mL ( 8 to 10 drops) of racemic epinephrine into nebulizer reservoir. Squeeze bulb 1 to 3 times in
partially opened mouth. If relief does not occur within 2 to 3 min, administer 2 to 3 additional
inhalations. Do not administer > q 3 hr. Aerosol-nebulizer: Add 0.5 mL ( 10 drops) racemic
epinephrine to 3 mL of diluent or 0.2 to 0.4 mL ( 4 to 8 drops) of MicroNefrin to 4.6 to 4.8 mL water.
Administer for 15 min q 3 to 4 hr. ADULTS SC/IM Solution (1:1000): 0.2 to 1 mL (0.2 to 1 mg); repeat
q 4 hr. SC Suspension (1:200): 0.1 to 0.3 mL (0.5 to 1.5 mg). IV Solution (1:10,000): 0.1 to 0.25 mg (1
to 2.5 mL) injected slowly. INFANTS AND CHILDREN: SC Solution (1:1000): 0.01 mL/kg or 0.3
mL/m2 (0.01 mg/kg or 0.3 mg/m2); repeat q 20 min to 4 hr. Do not exceed 0.5 mL (0.5 mg) in single
dose. Suspension (1:200): 0.005 mL/kg (0.025 mg/kg). Maximum single dose for children 30 kg is
0.15 mL (0.75 mg). IV Solution (1:10,000): 0.01mg/kg to 0.05 mg repeated at 20 to 30 min intervals.