Anti-Anginal Drugs

Type Drug Mechanism Specific Drug

Facts
Adverse Effect Notes
Organic
Nitrates
Nitroglycerin (Nitroglycerin NO guanylate cyclase cGMP
de(P) MLC contractile state of SM in venules
1. Dilation systemic venules reload ! ressure
"#in ventricle during diastole$ ressure gradient
from aorta$ coronary %lood flo"$ isc&emia !
angina
'. reload O' demand of cardiac muscle %y
tension in cardiac "alls$ does NO( directly c&ange
contractility of &eart
). Dilate large eicardial coronary vessels*
resistance of small coronary vessels remains
determined %y autoregulation
(meta%olites#isc&emia) Prevents +coronary steal,
- life of './
minutes$
su%lingual
0eadac&e (severe)1 di22iness1
"ea3ness
45se of nitrates and sildenafil
(6iagra) "it&in '7 &ours of eac&
ot&er life.t&reatening
&yotension
4(olerance* s&ould %e ta3en 8 time of anginal
attac3 or anticiation of e9ercise or stress*
continued e9osure leads to mar3ed attenuation
(interrut dosing for /.1' &ours#day:nig&t:
restores efficacy)
4P&armaco3inetics* %ioavaila%ility of oral organic
nitrates is ( caacity &eatic organic nitrate
reductase)$ su%lingual route avoids first ast ! is
raid (fe" mins)
Isosoride
dinitrate
- life of '.)
&ours$ c&e"a%le
Dihydropyridine
!-Type "a##
channel
loc$ers
Nifedipine ;ela9es vascular SM 8 lo"er < = t&an t&ose re>uired
for reducing calcium influ9 in cardiac cells
4Generally arterial resistance ! ?P (may %e
accomanied %y refle9 mediated CO)
4Cardiac deression$ cardiac
arrest$ %ardycardia$ eri&eral
edema$ constiation$ @6 %loc3$ C0A
4Contraindicated in atients "#
&eart failure and L6 dysfunction
44Note* Ca'B %loc3ers reload$
ris3 cardiac isc&emia C use "#
nitroglycerin
4NO(D* Nifediine C s&o"n to
ris3 of isc&emic &eart disease
Nimodipine affinity for
cere%ral vessels
and may
vasosasm !
mortality in
su%arac&noid
&emorr&age
Non-
dihydropyridine
!-Type "a##
channel
loc$ers
%erapamil 4Less otent vasodilator t&an di&ydroyridines
4D9erts effects on vasodilation @ND &eart
40;$ contractility$ rate of recovery of Ca
c&annels after oening and delay %efore Ca
c&annels can reoen (slo"s conduction t&roug& @6
node)
4Due to t&eir direct in&i%ition of conduction*
effective treatments for suerventricular
reentry tac&ycardia ! may %e %eneficial to
atients "# a &istory of atrial tac&ycardia1
flutter ! fi%rillation
Diltia&em Nonsecific
antagonism of
symat&etic
nervous system
'-adrenergic
receptor
antagonists
(ropanolol 0;* contractility$ meta%olic demands of &eart Note* com%o "#
nitrates
4Drectile dysfunction1 CNS
effects* deression1 insomnia
4Contraindicated* ast&matics (9E')
4Discussed "# anti.&yertensives1 %ut also useful
in treating angina and arr&yt&mias$ may
mortality after acute MF %y G1HI
Note* ?loc3ade of CaBB c&annels in vascular SM in&i%it CaBB influ9 ! evo3e rela9ation of arteriole1 %ut not venous1 SM. Fn coronary circulation CaBB c&annel %loc3ers
coronary resistance ! coronary %lood flo" "&ic& angina. Fn cardiac cells C %loc3ing of CaBB c&annels contractility of &eart li3eli&ood of isc&emia and angina
Nifediine 6eraamil
Coronary vasodilation BBBB BB
Peri&eral vasodilation BBBB BB
0; ;efle9 Decrease
Contractility ;efle9 Decrease
;ate of recovery of Ca c&annels No c&ange Decrease
Anti-Anginal Drugs
@6 conduction No c&ange Slo"s