module 6b Flashcards
Antianginal Drugs
Angina Pectoris (Chest Pain)
When the supply of oxygen and nutrients in
the blood is insufficient to meet the demands of the heart, the heart muscle “aches”
The heart requires a large supply of oxygen to meet the demands placed on it
Ischemia Poor blood supply to an organ Ischemic heart disease Poor blood supply to the heart muscle Atherosclerosis Coronary artery disease Myocardial infarction (MI) Necrosis, or death, of cardiac tissue Disabling or fatal
Ischemia
Chronic stable angina (also called classic or effort angina) Unstable angina also called preinfarction or crescendo angina) Vasospastic angina (also called variant angina)
Types of Angina
Nitrates/nitrites
(beta)-blockers
Calcium channel blockers
Drugs for Angina
Therapeutic Objectives
Increase blood flow to ischemic heart muscle
and/or
Decrease myocardial oxygen demand
Therapeutic Objectives
Minimize the frequency of attacks and decrease the duration and intensity of anginal pain
Improve the patient’s functional capacity with as few adverse effects as possible
Prevent or delay the worst possible outcome: MI
Nitrates/Nitrites
Available forms Sublingual* Buccal* Chewable tablets Ointments* Transdermal patches* Translingual sprays* Oral capsules/tablets Intravenous solutions* * Bypass the liver and the first-pass effect
Nitrates/Nitrites
Rapid-acting forms Used to treat acute anginal attacks Sublingual tablets; IV infusion Long-acting forms Used to PREVENT anginal episodes
Nitrates/Nitrites
Nitroglycerin
Large first-pass effect with oral forms
Used for symptomatic treatment of ischemic heart conditions angina)
IV form used for BP control in perioperative
hypertension, treatment of HF, ischemic pain,
pulmonary edema associated with acute MI, and hypertensive emergencies
Nitrates
isosorbide dinitrate (Isordil, Sorbitrate, Dilatrate SR) isosorbide mononitrate (Imdur Monoket ISMO) Imdur, Monoket, Used for: Acute relief of angina Prophylaxis in situations that may provoke angina Long-term prophylaxis of angina
Adverse effects of Nitrates
Headaches Usually diminish in intensity and frequency with continued use Tachycardia, postural hypotension Tolerance may develop
Tolerance
Occurs in patients taking nitrates around the clock or with long-acting forms
Prevented by allowing a regular nitrate-free period
Transdermal forms: remove patch at bedtime for 8 hours, then apply a new patch in the morning
atenolol (Tenormin)
metoprolol (Lopressor)
propranolol Inderal)
nadolol (Corgard)
BETA-Blockers
Beta blockers MOA
Block B1-receptors on the heart
Decrease HR, resulting in decreased myocardial
oxygen demand and increased oxygen delivery to the heart
Decrease myocardial contractility, helping to
conserve energy or decrease demand
Beta blockers MOA
After an MI, a high level of circulating catecholamines stimulate the heart, causing an imbalance in supply and demand ratio and even leading to life-threatening dysrhythmias.
B-blockers block the harmful effects of
catecholamines, thus improving survival after an MI
Indications of Beta blockers
Angina
hypertension
Cardiac dysrhythmias
Cardioprotective effects, especially after MI
Some used for migraine headaches, essential
tremors, and stage fright
Beta blockers Adverse effects
CNS Dizziness, fatigue, mental depression lethargy,depression, lethargy, drowsiness
Cardiovascular:Bradycardia, hypotension,
heart block heart failure
Beta blockers Adverse effects
Metabolic Altered glucose and lipid
metabolism
Other:Impotence, wheezing,
dyspnea
verapamil (Calan, Isoptin)
diltiazem (Cardizem)
nifedipine (Procardia)
amlodipine (Norvasc)
Calcium Channel Blockers
Calcium Channel Blockers MOA
Cause coronary artery vasodilation
Cause peripheral arterial vasodilation decreasing vasodilation, systemic vascular resistance
Reduce the workload of the heart
Result: decreased myocardial oxygen demand
Calcium Channel Blockers Indications
First-line drugs for treatment of angina, hypertension, and supraventricular tachycardia
Coronary artery spasms
Short-term management of atrial fibrillation and flutter
Calcium Channel Blockers adverse effects
Very acceptable adverse effect and safety profile
May cause hypotension, palpitations, tachycardia or bradycardia, constipation, nausea, dyspnea
