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  • General
    • MOA: Primarily vasodilators that dilate, veins, arterioles, and particularly the coronary arteries by relaxing vascular smooth muscle cells, but also venodilators
      • Their primary anti-ischemic effects are due to systemic vasodilation and decreasing cardiac preload (lowering LVEDV and LVESV) rather than coronary vasodilation
      • This causes reduced LV wall stress reducing myocardial oxygen demand, and relieving anginal symptoms
      • Arterial and arteriolar vasodilation can decrease SVR and blood pressure, but to a lesser degree
      • They do act as coronary vasodilators, but benefit is uncertain
        • No direct effect on cardiac chronotropy, inotropy (contractility), LVEF
    • USE: Chest pain relief in patients with chronic stable angina and ACS
    • SE: Reflex Tachycardia
      • Concomitant use of beta-blockers to prevent
  • Isosorbide Dinitrate
    • USE:
      • FDA Approved: Prevention or treatment (glyceryl trinitrate preferred) of angina pectoris from CAD
      • Non-FDA Approved: Achalasia, DES
  • Isosorbide Mononitrate
  • Sodium Nitroprusside
    • Parenteral vasodilator with quick onset and offset of action and is commonly used for rapid BP control in patients with hypertensive emergency
      • Its metabolism releases NO and Cyanide
        • Induces arteriolar and venous vasodilation
      • May cause reflex tachycardia and enhance ventricular contraction increasing aortic wall stress (give BB first)
    • SE: Irreversible Cyanide toxicity (Thiocyanate, most common in renal insufficiency), disorientation, Headache, tinnitus, Tachyphylaxis
    • IV: Use only for patients with ACS or Acute pulmonary edema
    • Avoid in patients with RV infarction and those on PDE-5 inhibitors


  • Ranolazine (Ranexa)
    • MOA: Partially inhibits fatty acid oxidation and increases glucose oxidation
    • Dose: 500-1000mg BID
    • USE:
      • IIa: Chronic Stable Angina Refractory to other anti-anginal therapy
      • Increases exercise tolerance/duration
    • SE: QTc prolongation in liver disease
      • No HR or BP reduction