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1、CardiovasculardrugsAntianginaldrugsThethreemaintypesofanginaare:·stableangina(anginaofeffort),whereatherosclerosisrestrictsbloodflowinthecoronaryvessels;attacksareusuallycausedbyexertionandrelievedbyrest·unstableangina(acutecoronaryinsufficiency),whichisconsideredtobeanintermediatesta
2、gebetweenstableanginaandmyocardialinfarction·Prinzmetalangina(variantangina),causedbycoronaryvasospasm,inwhichattacksoccuratrest.Managementdependsonthetypeofanginaandmayincludedrugtreatment,coronaryarterybypasssurgery,orpercutaneoustransluminalcoronaryangioplasty.StableanginaDrugsareu
3、sedbothforthereliefofacutepainandforprophylaxistoreducefurtherattacks;theyincludeorganicnitrates,beta-adrenoceptorantagonists(beta-blockers),andcalcium-channelblockers.NITRATESOrganicnitrateshaveavasodilatingeffect;theyaresometimesusedalone,especiallyinelderlypatientswithinfrequentsym
4、ptoms.Toleranceleadingtoreducedantianginaleffectisoftenseeninpatientstakingprolonged-actionnitrateformulations.Evidencesuggeststhatpatientsshouldhavea‘nitrate-free’intervaltopreventthedevelopmentoftolerance.Adverseeffectssuchasflushing,headache,andposturalhypotensionmaylimitnitratethe
5、rapybuttolerancetotheseeffectsalsosoondevelops.Theshort-actingsublingualformulationofglyceryltrinitrateisusedbothforpreventionofanginabeforeexerciseorotherstressandforrapidtreatmentofchestpain.Asublingualtabletofisosorbidedinitrateismorestableinstoragethanglyceryltrinitrateandisuseful
6、inpatientswhorequirenitratesinfrequently;ithasasloweronsetofaction,buteffectspersistforseveralhours.BETA-BLOCKERSBeta-adrenoceptorantagonists(beta-blockers),suchasatenolol,blockbeta-adrenergicreceptorsintheheart,andtherebydecreaseheartrateandmyocardialcontractilityandoxygenconsumption
7、,particularlyduringexercise.Beta-blockersarefirst-linetherapyforpatientswitheffort-inducedchronicstableangina;theyimproveexercisetolerance,relievesymptoms,reducetheseverityandfrequencyofanginaattacks,andincreasetheanginalthreshold.Beta-blockersshouldbewithdrawngraduallytoavoidprecipit
8、ating
