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Nitrates are the oldest in the treatment of this disease, its effect is based on producing smooth muscle relaxation with subsequent venodilation and reduced preload, peripheral arterial vasodilation with afterload reduction, decreased with increased wall stress diastolic coronary flow, and relaxation of collateral vessels, particularly in coronary disease. The most common undesirable effects are headache, flushing and mild tachycardia. The sublingual NTG treatment is central to the AP, which should be used as a prophylactic, ie, before making an effort known to cause angina. The long-acting nitrates such as isosorbide mononitrate (MNI) are effective between 4-6 h, with the precaution of having a period of not less than 12 hours between the last and the first dose to avoid the phenomenon of tolerance, resulting a reduction or cancellation of its effect due to inadequate management, 18 it tends to depletion of sulfhydryl groups at the level of vascular smooth muscle by continuous exposure to the drug, 19 or loss of the hemodynamic effects of vasodilation by decreasing the volume plasma or by mechanisms neurohormonales.20
Beta blockers are extremely useful in the treatment of this entity because of its many effects, of which the most important are the decrease in blood pressure and heart rate thereby reducing myocardial oxygen consumption. These effects are maintained during exercise, thereby increasing the tolerance to these. Their most common adverse reactions are symptomatic bradycardia, atrioventricular block and bronchospasm We therefore should not be administered to patients with heart failure, conduction disorders, bronchial asthma or chronic obstructive pulmonary disease (COPD) and should be given with caution in diabetic patients and patients with peripheral arterial insufficiency.
In our country the best known are beta blockers propranolol and atenolol. Customized Fat Loss Free Review The first has a half life of 3-6 h, the dose ranges from 10-240 mg. The atenolol blood remains in 6-10 hours, and dosage is between 50-100 mg per day. In general you want a heart rate of 60 beats / min at rest.
The introduction of calcium antagonists has added an important benefit to the treatment of AP, they produce vasodilation and decreased cardiac oxygen consumption. The agents used are nifedipine and verapamil diltizem, which differ in some respects in relation to its effect on the cardiovascular system. For example, nifedipine produces greater vasodilator effect and may cause headache, peripheral edema and flushing; verapamil affects conduction system and may produce bradycardia and even blocks (should be caution when using this associated with a beta blocker), the diltiazem, meanwhile, is intermediate between the two with greater myocardial depressant effect. The half-life of nifedipine is about 5 h at a dose between 10-30 mg 3-4 times / day, verapamil blood remains between 3-7 h with a dose ranging from 80-160 mg 3 times daily , fat loss program and diltiazem have a half life of 4 hours with a dose of 90 mg 1 or 3 times / day.
Recently new drugs have been added, including those derived from research at the molecular level effect on the heart muscle as molsidomine, sustained and gradually decreasing the preload resulting in reduction of myocardial wall stress with a subsequent decrease in consumption oxygen improves endocardial perfusion and increases ejection fraction (EF). The dose ranges from 4-6 mg / day, and their most frequent undesirable effects are headache and hypotension.
Another new drug is effective trimetazidina21 cytoprotective antianginal and because they retain cellular structures and functions of the effects of ischemia and hypoxia, or metabolic disturbances that result from them. The dose is 20 mg 2-3 times daily, and the most common side effects are nausea and vomiting.
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