1) Angina pectoris is a pressure-like chest pain caused by cardiac ischemia due to coronary artery disease. There are three main types: stable angina provoked by exertion, variant angina occurring unpredictably at rest, and unstable angina with increased frequency and severity of attacks.
2) Antianginal drugs work by reducing oxygen demand or increasing oxygen delivery. Examples include nitrates like nitroglycerin to abort attacks, beta blockers to decrease heart rate and workload, and calcium channel blockers to relax coronary arteries.
3) Common side effects of these drugs include headaches with nitrates and hypotension, but they are effective at decreasing angina attacks and increasing exercise tolerance.
1) Angina pectoris is a pressure-like chest pain caused by cardiac ischemia due to coronary artery disease. There are three main types: stable angina provoked by exertion, variant angina occurring unpredictably at rest, and unstable angina with increased frequency and severity of attacks.
2) Antianginal drugs work by reducing oxygen demand or increasing oxygen delivery. Examples include nitrates like nitroglycerin to abort attacks, beta blockers to decrease heart rate and workload, and calcium channel blockers to relax coronary arteries.
3) Common side effects of these drugs include headaches with nitrates and hypotension, but they are effective at decreasing angina attacks and increasing exercise tolerance.
1) Angina pectoris is a pressure-like chest pain caused by cardiac ischemia due to coronary artery disease. There are three main types: stable angina provoked by exertion, variant angina occurring unpredictably at rest, and unstable angina with increased frequency and severity of attacks.
2) Antianginal drugs work by reducing oxygen demand or increasing oxygen delivery. Examples include nitrates like nitroglycerin to abort attacks, beta blockers to decrease heart rate and workload, and calcium channel blockers to relax coronary arteries.
3) Common side effects of these drugs include headaches with nitrates and hypotension, but they are effective at decreasing angina attacks and increasing exercise tolerance.
1) Angina pectoris is a pressure-like chest pain caused by cardiac ischemia due to coronary artery disease. There are three main types: stable angina provoked by exertion, variant angina occurring unpredictably at rest, and unstable angina with increased frequency and severity of attacks.
2) Antianginal drugs work by reducing oxygen demand or increasing oxygen delivery. Examples include nitrates like nitroglycerin to abort attacks, beta blockers to decrease heart rate and workload, and calcium channel blockers to relax coronary arteries.
3) Common side effects of these drugs include headaches with nitrates and hypotension, but they are effective at decreasing angina attacks and increasing exercise tolerance.
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Antianginal drugs
Dr. Jim Amisi
Angina pectoris • Angina pectoris refers to a strangling or pressure-like pain caused by cardiac ischemia. Occurs as a result of Coronary artery disease(CAD) • The pain is usually located substernally but is sometimes perceived in the neck, shoulder and arm, or epigastrium Types of angina • Stable angina(classic angina)- predictably provoked by exercise, emotion or eating and subside when the increased energy demand is withdrawn • Variant angina(vasospastic angina)- attacks occur at rest or during sleep and are unpredictable • Unstable angina (Acute coronary syndrome)- characterized by increased frequency and severity of attacks that result from a combination of atherosclerotic plaques, platelet aggregation at fractured plaques, and vasospasm. Antianginal drugs • Drugs used in angina exploit two main strategies: – reduction of oxygen demand – increase of oxygen delivery to the myocardium Antianginal drugs a) Nitrates – Short acting: Glyceryl trinitrate (GTN, Nitroglycerine) – Long acting: Isosorbide dinitrate (short acting by sublingual route), Isosorbide, mononitrate, Erythrityl tetranitrate, Pentaerythritol tetranitrate
b) β Blockers: Propranolol, Metoprolol, Atenolol and others
Clinical classification • Used to abort or terminate attack: GTN, Isosorbide dinitrate (sublingually) • Used for chronic prophylaxis: All other drugs Organic nitrates • They are converted to of NO. NO activates the soluble isoform of guanylyl cyclase, thereby increasing intracellular levels of cGMP. This leads to the relaxation of coronary artery smooth muscle ADRS • Headache is the most common adverse effect of nitrates • High doses of nitrates can also cause postural hypotension, facial flushing, and tachycardia β-adrenergic blockers • The β-adrenergic blockers decrease the oxygen demands of the myocardium by blocking β1 receptors, resulting in decreased heart rate, contractility, cardiac output and blood pressure • All β blockers are nearly equally effective in decreasing frequency and severity of attacks and in increasing exercise tolerance in classical angina, but cardioselective agents (atenolol, metoprolol) are preferred over nonselective β1 + β2 blockers (e.g. propranolol) Calcium channel blockers • Reduce oxygen demand by inhibiting calcium entry into the myocardial smooth cells
