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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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