CARDIOVASCULAR PHARMACOLOGY
MNA Program
Fall 1999

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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