Last updated 04/10/00 12:26 PM
5. Your patient's exertional angina is now refractory to the combination of nitroglycerin and propranolol, so her physician added a Ca2+ channel blocker to the regime. Discuss the rationale for co-administering the ß-blocker and nitrate (for initially treating the angina) and which Ca2+ channel blocker (i.e., verapamil, diltiazem or nimodipine) would be indicated (and why).
NO vasodilation venous pooling preload cardiac work.
NO can result in reflex tachycardia which the ß-blocker will blunt.
Ca2+ channel blockers
Verapamil has affinity for AV node
Nimodipine has affinity for cerebral vessels
Diltiazem best choice
Also ß-blocker MVO2 demand on heart by CO and HR
Brody Page 18
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