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Anti anginal drugs

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Prashiddha Dhakal
Prashiddha Dhakal

This document discusses anti-anginal drugs. It describes the types of angina and the pharmacological goals of decreasing preload, afterload, and heart rate. The main classes of anti-anginal drugs discussed are nitrates, beta blockers, calcium channel blockers, and potassium channel openers. Nitrates work by relaxing blood vessels to reduce preload and afterload. Beta blockers have negative effects on heart rate and contractility. Calcium channel blockers block calcium channels in the heart and blood vessels. Potassium channel openers open potassium channels to cause vessel dilation. The document provides details on specific drugs in each class and their uses for stable, variant, and unstable angina.

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ANTI- ANGINAL DRUGS Prashiddha Dhakal MBBS (KUSMS, 11th)
What Is Angina? Central chest discomfort or pain due to transient ishemia of the myocardium Pain may radiate to one arm OR to both arms OR to neck OR to jaw OR to the epigastrium Duration- Less than 20min
Types Of Angina Classical/Typical/Stable/Exertional Angina Due to fixed and stable plaque Prinzmetal/Variant Angina Due to spasm of coronary artery Unstable Angina Due to unstable plaque (賊 thrombus)
Pharmacological Goals & Drugs Classification Preload (Venodilation) Nitrates, Potassium Channel Openers Afterload (Arteriolodilation) Calcium Channel Blockers, Potassium Channel Openers Heart Rate Beta Blockers, Calcium Channel Blockers Dilate Coronary Artery Dipyridamole
NITRATES Nitroglycerine, Isosorbide Dinitrate, Isosorbide Mononitrate Release Nitric Oxide in smooth muscles of Veins(mainly) & Arterioles Stimulate Guanylyl Cyclase & cGMP Stimulate Protein Kinase G Dephosphorylation & inactivation of MLCK Relaxation of vascular smooth muscle
NITRATES Venodilation Venous Return Preload Venodilation intraventricular pressure less compression on vessels supplying subendocardial myocardium Perfusion Arteriolodilation TPR Afterload Dilates collateral pathways & provides blood to ischemic area
NITRATES
BETA BLOCKERS Non-selective - Propanolol Cardioselective (硫1) - Atenolol, Metoprolol Have following actions : -ve Chronotropy (SA Node) -ve Dromotropy (AV Node) -ve Inotropy (Contractile myocardium) -ve Clinotropy (Velocity of contraction & relaxation)
BETA BLOCKERS Adverse Effects Fatigue (Blockade of 硫2 receptors in blood vessels supplying skeletal muscles) Bradycardia (Blockade of 硫1 receptors in heart) Precaution Abrupt withdrawal can heart rate, contractility & cause arrythmia & even MI. (Upregulation of receptors)
BETA BLOCKERS Contraindications Prinzmetal Angina COPD, Asthma,Bronchiectesias (硫2 in lungs) Diabetes Mellitus(硫2 in liver & pancreas) Raynauds Disease(硫2 in peripheral blood vessels) Bradyarrythmias (硫1 in heart) Depression
CALCIUM CHANNEL BLOCKERS Phenyl Alkylamines- Verapamil Benzothiazepines- Diltiazem Dihydropyridines- Nifedipine, Amlodipine, Felodipine Blocks voltage gated L-type Ca channels present in cardiac & vascular smooth muscles
CALCIUM CHANNEL BLOCKERS Depending upon their types, they can have following actions : -ve Chronotropy (SA Node) -ve Dromotropy (AV Node) -ve Inotropy (Contractile myocardium) -ve Clinotropy (Velocity of contraction & relaxation) Afterload (Arteriolodilatation)
CALCIUM CHANNEL BLOCKERS HEART ARTERIOLES Verapamil ++++ + Diltiazem ++ ++ Dihydropyridines - ++++ Adverse Effects Verapamil- similar to Beta Blockers Dihydropyridines- similar to Nitrates Diltiazem- common to above two
POTASSIUM CHANNEL OPENERS Nicorandil, Pinacidil Opens Potassium channels in vascular smooth muscles & causes K efflux resulting into the hyperpolarization of the cell. Venodilation- Preload Arteriolodilation- Afterload
PHARMACOTHERAPY FOR ANGINA Stable Angina Acute attack- NTG 0.5mg S/L Prophylaxis- Nitrates- Isosorbide Mononitrate, Transdermal NTG 硫 Blockers- Propanolol, Atenolol, Metoprolol CCB-Amlodipine, Verapamil SR & Diltiazem SR
PHARMACOTHERAPY FOR ANGINA Variant Angina Acute- NTG S/L or I/V Prophylaxis- Nitrates- Isosorbide Mononitrate CCB-Amlodipine, Diltiazem SR Potassium Channel Openers- Nicorandil, Pinacidil 硫 BLOCKERS ARE CONTRAINDICATED
PHARMACOTHERAPY FOR ANGINA Unstable Angina NTG S/L Antiplatelets agent- Aspirin, Clopidogrel 硫 Blockers- Atenolol, Metoprolol CCB- Amlodipine or Nifedipine SR LMW Heparin
Anti anginal drugs

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Anti anginal drugs

  • 1. ANTI- ANGINAL DRUGS Prashiddha Dhakal MBBS (KUSMS, 11th)
  • 2. What Is Angina? Central chest discomfort or pain due to transient ishemia of the myocardium Pain may radiate to one arm OR to both arms OR to neck OR to jaw OR to the epigastrium Duration- Less than 20min
  • 3. Types Of Angina Classical/Typical/Stable/Exertional Angina Due to fixed and stable plaque Prinzmetal/Variant Angina Due to spasm of coronary artery Unstable Angina Due to unstable plaque (賊 thrombus)
  • 4. Pharmacological Goals & Drugs Classification Preload (Venodilation) Nitrates, Potassium Channel Openers Afterload (Arteriolodilation) Calcium Channel Blockers, Potassium Channel Openers Heart Rate Beta Blockers, Calcium Channel Blockers Dilate Coronary Artery Dipyridamole
  • 5. NITRATES Nitroglycerine, Isosorbide Dinitrate, Isosorbide Mononitrate Release Nitric Oxide in smooth muscles of Veins(mainly) & Arterioles Stimulate Guanylyl Cyclase & cGMP Stimulate Protein Kinase G Dephosphorylation & inactivation of MLCK Relaxation of vascular smooth muscle
  • 6. NITRATES Venodilation Venous Return Preload Venodilation intraventricular pressure less compression on vessels supplying subendocardial myocardium Perfusion Arteriolodilation TPR Afterload Dilates collateral pathways & provides blood to ischemic area
  • 8. BETA BLOCKERS Non-selective - Propanolol Cardioselective (硫1) - Atenolol, Metoprolol Have following actions : -ve Chronotropy (SA Node) -ve Dromotropy (AV Node) -ve Inotropy (Contractile myocardium) -ve Clinotropy (Velocity of contraction & relaxation)
  • 9. BETA BLOCKERS Adverse Effects Fatigue (Blockade of 硫2 receptors in blood vessels supplying skeletal muscles) Bradycardia (Blockade of 硫1 receptors in heart) Precaution Abrupt withdrawal can heart rate, contractility & cause arrythmia & even MI. (Upregulation of receptors)
  • 10. BETA BLOCKERS Contraindications Prinzmetal Angina COPD, Asthma,Bronchiectesias (硫2 in lungs) Diabetes Mellitus(硫2 in liver & pancreas) Raynauds Disease(硫2 in peripheral blood vessels) Bradyarrythmias (硫1 in heart) Depression
  • 11. CALCIUM CHANNEL BLOCKERS Phenyl Alkylamines- Verapamil Benzothiazepines- Diltiazem Dihydropyridines- Nifedipine, Amlodipine, Felodipine Blocks voltage gated L-type Ca channels present in cardiac & vascular smooth muscles
  • 12. CALCIUM CHANNEL BLOCKERS Depending upon their types, they can have following actions : -ve Chronotropy (SA Node) -ve Dromotropy (AV Node) -ve Inotropy (Contractile myocardium) -ve Clinotropy (Velocity of contraction & relaxation) Afterload (Arteriolodilatation)
  • 13. CALCIUM CHANNEL BLOCKERS HEART ARTERIOLES Verapamil ++++ + Diltiazem ++ ++ Dihydropyridines - ++++ Adverse Effects Verapamil- similar to Beta Blockers Dihydropyridines- similar to Nitrates Diltiazem- common to above two
  • 14. POTASSIUM CHANNEL OPENERS Nicorandil, Pinacidil Opens Potassium channels in vascular smooth muscles & causes K efflux resulting into the hyperpolarization of the cell. Venodilation- Preload Arteriolodilation- Afterload
  • 15. PHARMACOTHERAPY FOR ANGINA Stable Angina Acute attack- NTG 0.5mg S/L Prophylaxis- Nitrates- Isosorbide Mononitrate, Transdermal NTG 硫 Blockers- Propanolol, Atenolol, Metoprolol CCB-Amlodipine, Verapamil SR & Diltiazem SR
  • 16. PHARMACOTHERAPY FOR ANGINA Variant Angina Acute- NTG S/L or I/V Prophylaxis- Nitrates- Isosorbide Mononitrate CCB-Amlodipine, Diltiazem SR Potassium Channel Openers- Nicorandil, Pinacidil 硫 BLOCKERS ARE CONTRAINDICATED
  • 17. PHARMACOTHERAPY FOR ANGINA Unstable Angina NTG S/L Antiplatelets agent- Aspirin, Clopidogrel 硫 Blockers- Atenolol, Metoprolol CCB- Amlodipine or Nifedipine SR LMW Heparin