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Clinical pharmacy 2024/2025 Level 3 Pharm D Pharmacology 1 (PO 502)

2- β-Blockers

 Examples: Propranolol, metoprolol, atenolol, nadolol.

 used in a dose that keep HR at 60 /min does not exceed
Used in
:
.
 Angina P.: Prophylactic against exertional angina (stable)
.
 Post MI: Reducing the risk of sudden death or reinfarction following acute MI
 Hypertension: mild-moderate types
.
 Cardiac arrhythmias (SVT) & control palpitations and tachycardia caused by

.
hyperthyroidism
 Chronic HF (Carvedilol)

MOA
:
 β1 blockade in the heart → all myocardial properties→ cardiac output and

cardiac work → oxygen demand .
 Most β-blockers are similarly effective despite pharmacological differences
.
β-blockers are the only antianginal agents that prolong patient’s life (decrease

mortality rate) and so,
 commonly used post MI .
 used as first line in chronic angina pectoris
Note

 Beta-blockers may worsen vasospastic angina
➢ Coronary arteries contain both α1 (VC) and β2 (VD) receptors.

➢ Because of unopposed α-adrenoceptor- mediated more coronary
vasoconstriction .
➢ So, β-blockers are contraindicated in vasospastic angina.

3- CCB (Nifedipine) ➔ VD + decrease inflammation

Dihydropyridines: Non-Dihydropyridines :
Amlodipine Verapamil
Nicardipine Diltiazem
Nifedipine

MOA

.
➢ Arteriodilation:  afterload → myocardial oxygen demand
➢ Coronary dilation:  coronary blood flow due to coronary artery dilation, 
oxygen supply
.
➢ Myocardial depression→ cardiac works → oxygen demand (only with

verapamil and diltiazem).

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