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DRUG SELECTION IN ANGINA

A. Atherosclerotic angina:
1. Treatment of the acute attack:
* Nitrates: sublingual nitroglycerine or isosorbide.
* Calcium channel blockers: sublingual nifedipine.
2. Prophylaxis: (Combination of 2 groups more effective than a
single group)
* Nitrates: oral, topical ointment, or transdermal
nitroglycerine, oral isosorbide dinitrate.
* Beta blockers: oral propranolol, nadolol.
* Calcium channel blockers: oral diltiazem, nifedipine, or
verapamil.
B. Vasospastic angina:
1. Treatment of the acute attack:
* Nitrates: sublingual nitroglycerine, isosorbide.
* Calcium channel blockers: diltiazem, nifedipine,
verapamil.
2. Prophylaxis:
* Calcium channel blockers: diltiazem, nifedipine,
verapamil.
* Nitrates: buccal, oral, or topical nitroglycerine.
C. Unstable angina:
* Nitrates: intravenous nitroglycerine.
* Calcium channel blockers: oral verapamil.
* Beta blockers: propranolol.
* Adjunctive therapy: Aspirin, heparin.

References:
1. Symposium: Circulation 1985; 72 (Suppl V).
2. Takaro T et al: The Veterans Administration Cooperative
Study of Stable Angina: Current status. Circulation 1982;
65 (Suppl 2): 60.
3. Gersh B J et al: Comparison of coronary artery bypass
surgery and medical therapy in patients 65 years of age or
older. N Engl J Med 1985;313:217.
4. Morse JR, Nesto RW: Double-blind crossover comparison of
the
antianginal effects of nifedipine and isosorbide dinitrate
in patients with exertional angina receiving propranolol. J
Am Coll Cardiol 1985; 6: 1395.


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