Angina Flashcards
An imbalance between myocardial O2 supply and demand
Angina
3 main drugs used in treatment of Angina
Organic nitrates
Beta blockers
Ca channel blockers
Organic nitrates
Nitroglycerin and isosorbide dinitrate and isosorbide mononitrate
There bioavailability is 10%
Nitroglycerin and isosorbide
Has higher bioavailability and long duration of action
Isosorbide mononitrate
Metabolized by liver 90%
Nitroglycerin and isosorbide dinitrate
It’s excretion is largely by kidney in the form of glucuronide
Isosorbide mononitrate
Organic nitrates roles
✓Smooth muscle relaxation
✓Dec O2 demand by Dec work of hear
✓Dec preload and after load
✓Inc O2 supply by increasing coronary flow
✓Spasmolytic on smooth muscle
Uses of organic nitrates
✓All type of angina
In acute Angina give nitroglycerin or isosorbide dinitrate
✓ In chronic angina give long acting preparations
✓Myocardial infarction
✓Acute heart failure
✓Acute pulmonary edema
✓Spasmolytic
Adverse effects of organic nitrates
Inc IOP and glaucoma
Facial flushing
Tachycardia
Postural hypotension
Tolerance
Coronary dependence
Contraindications of organic nitrates
✓Sildenafil
✓Hypertrophic obstructive ✓cardiomyopathy right ventricle infarction
✓Volume depletion
✓Severe aortic stenosis
Beta blocker drugs
Metaprolol and atenolol
Uses of beta blockers
Prophylactic
Myocardial infarction
Safely used with diapetes and peripheral vascular disease
Contraindications of Beta blocker
✓Variant angina
✓Should not be stopped suddenly
✓Never combine
✓Bradycardia or asthma
Ca channel blockers
Dihydropyridine
Non dihydropyridine
Dihydropyridine
Amoldipine (long acting)
Nifedipine ( short acting)
Non dihydropyridine
Verapamil
Diltiazem
Ca channel blocker that affects myocardium
Verapamil
Ca channel blocker that exert effect on smooth muscles
Amoldipine and nifedipine
Ca channel blocker that is intermediate in it’s action
Diltiazem
Uses of Ca channel blocker
All types of angina
Angina + arrhythmia we will select which drug?
Verapamil or diltiazem
Favorable combination in angina+Arrhythmia case
Verapamil and nitrate
Unfavorable combination in case of angina+ Arrhythmia
Verapamil and beta blocker
Angina+ hypertension or Bronchial spasm what drug is the best choice?
Nifedipine
Favorable combination in case of angina+hypertension or Bronchial asthma
Nifedipine and beta blocker
Unfavorable combination in case of angina+hypertension or Bronchial asthma
Nifedipine and nitrate
Adverse effects of non dihydropyridine
Bradycardia
Heart block
Hypotension
Heart failure
Constipation
Adverse effects of dihydropyridine
Inc HR
Headache
Flushing
Ankle oedema
✓Drug interactions
Verapamil lead to …
Decrease renal excretion of digoxin
Drug interactions
Verapamil+ beta blockers lead to …
Severe cardiac depression
Nifedipine+ nitrate lead to
Severe hypotension and tachycardia
Potassium channel blocker drug is
Nicorandil
A drug which is both arterial and a venous dilator
Nicorandil
Adverse effects of nicorandil
Headache
Flushing
Dizziness
Drug used for patients while they are waiting surgery or angioplasty
Nicorandil
Metabolic modulators ( cytoprotective)
Na channel blocker
Trimetazidine
Ivabradine
A drug Which is a Na channel blocker
Ranolazine
Uses of ranolazine
In chronic angina
Adverse effects of ranolazine
Headache
Dizziness
Constipation
Prolongation of QT interval
Contraindications of ranolazine
With other drugs that prolong QT interval
Drug which inhibits beta oxidation of fatty acids which enhances glucose oxidation
Trimetazidine
Uses of trimetazidine
Stable angina
Taken orally
Drug which inhibits the pacemaker leading to decrease cardiac pacemaker activity
Ivabradine
Slowing the heart rate and allowing more time for blood to flow to the myocardium
Ivabradine
Drugs that decrease after and preload by arteriodilation
Ca channel blocker
Nifedipine and amoldipine
By venodilation
Nitrates
Coronary vasodilation
Nitrates
Ca channel blocker : nifedipine and amoldipine
Opening of collaterals and redistribution of blood to ischemic ares
Nitrates
