DƯỢC LÍ Goodman & Gilman's The Pharmacological Basis of Therapeutics 12th, 2010

Table 27–3
Recommended Drug Therapy for Angina in Patients with Other Medical Conditions
RECOMMENDED TREATMENT (AND
CONDITION ALTERNATIVES) FOR ANGINA DRUGS TO AVOID
Medical Conditions
Systemic hypertension
β receptor antagonists
(Ca 2+ channel antagonists)
Migraine or vascular headaches β receptor antagonists
(Ca 2+ channel antagonists)
Asthma or chronic obstructive Verapamil or diltiazem β receptor antagonists
pulmonary disease with
bronchospasm
Hyperthyroidism
β receptor antagonists
Raynaud’s syndrome Long-acting, slow-release Ca 2+ antagonists β receptor antagonists
Insulin-dependent diabetes
β receptor antagonists
mellitus
(particularly if prior MI) or long-acting,
slow-release Ca 2+ channel antagonists
Non-insulin-dependent
β receptor antagonists or
diabetes mellitus
long-acting, slow-release Ca 2+ channel
antagonists
Depression Long-acting, slow-release β receptor antagonists
Ca 2+ channel antagonists
Mild peripheral vascular
β receptor antagonists
disease
or Ca 2+ channel antanogists
Severe peripheral vascular Ca 2+ channel antagonists β receptor antagonists
disease with rest ischemia
Cardiac Arrhythmias and Conduction Abnormalities
Sinus bradycardia Dihydropyridine Ca 2+ channel antagonists β receptor antagonists,
diltiazem, verapamil
Sinus tachycardia (not due
β receptor antagonists
to heart failure)
Supraventricular tachycardia Verapamil, diltiazem, or
β receptor antagonists
Atrioventricular block Dihydropyridine Ca 2+ channel β receptor antagonists,
antagonists
diltiazem, verapamil
Rapid atrial fibrillation
Verapamil, diltiazem, or
(with digitalis)
β receptor antagonists
Ventricular arrhythmias
β receptor antagonists
Left Ventricular Dysfunction
Congestive heart failure
Mild (LVEF ≥40%)
β receptor antagonists
Moderate to severe (LVEF <40%) Amlodipine or felodipine (nitrates)
Left-sided valvular heart disease
Mild aortic stenosis
β receptor antagonists
Aortic insufficiency
Long-acting, slow-release dihydropyridines
Mitral regurgitation
Long-acting, slow-release dihydropyridines
Mitral stenosis
β receptor antagonists
Hypertrophic cardiomyopathy β receptor antagonists, non-dihydropyridine Nitrates, dihydropyridine
Ca 2+ channel antagonists
Ca 2+ channel antagonists
MI, myocardial infarction; LVEF, left ventricular ejection fraction. (Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM, Grunwald MA,
Levy D, Lytle BW, O’Rourke RA, Schafer WP, Williams SV. ACC/AHA/ACP-ASIM. Guidelines for the management of patients with chronic stable
angina: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on the Management
of Patients With Chronic Stable Angina). J Am Coll Cardiol 1999; 33:2092–197. Copyright © 1999 by the American College of Cardiology Foundation.)