UNIT 1: CHAPTER 2: ANTIANGINAL DRUGS Flashcards
ISCHEMIC HEART DISEASE (IHD) aka
Aka: Coronary Artery Disease (CAD) Coronary Heart Disease (CHD)
Is a type of heart disease that develops when the arteries of the heart cannot deliver oxygen-rich blood to the heart thereby, insufficient oxygenated blood reaches the myocardial cells.
ISCHEMIC HEART DISEASE (IHD)
Is a form of paroxysmal chest pain that is felt beneath the sternum, and commonly radiates down the left arm and/or shoulder. It can also radiate or originate in the neck or upper back.
Angina Pectoris
Decreased oxygenation of myocardium but the cells are still viable.
Ischemia
Tissue death (necrosis) due to inadequate blood supply to the affected area
Infarction
Causes of Angina Pectoris
1.Obstructiontocoronaryflow(atheromatous,classic angina).
2. Spasm(variantangina).
3. Others:Hypovolemia,anemia
Blood clot sticking to coronary arteries
Thrombosis
Stable Angina aka
•Chronic Stable Angina Pectoris (CSAP)
•Effort Angina
• Exertional Angina
• Classic Angina
• Typical Angina
Pain is often described as tightness, heaviness, or pressure- like feeling on the chest (not a sharp pain).
Stable Angina
Lasts about 2-5 minutes and can be relieved by sublingual nitrates.
Stable angina
Patients place a clenched fist over their sternum when describing their symptoms
Levine Sign
Most common form of angina (approx. 90%)
Stable Angina
Occurs most frequently in the morning.
Stable angina
Common triggers of Stable angina
- Exertion
- Emotional stress
- Exposure to cold or hot/humid environment
- Eating a heavy meal
Variant angina aka
• Vasospastic Angina
• Prinzmetal Angina
Coronary artery vasospasm (endothelial dysfunction/ damage or smooth muscle hyperactivity.
Vasospastic Angina
Unstable angina aka
• Acute Coronary Syndrome (ACS)
• Rest Angina
Often degenerates to Myocardial Infarction.
Unstable angina
A sudden increase in severity, frequency, and duration of pain of ischemic episode.
Unstable angina
Causes of Unstable Angina
- Coronary thrombosis
- Rupture of
atherosclerotic plaque (complete blockade)
Decreased by Nitrates
Venodilation
Amount of blood present in ventricles prior contraction
Preload
Increases by nitrates and CCBs
Arteriodilators
Decreased by N-blockers and some CCB’s
•NON - DHP
• Verapamil
• Diltiazem
a surgical procedure used to treat coronary heart disease.
Coronary artery bypass graft surgery
Nitrates/Nitrovasodilators effects
- Selective Venodilation (low doses)
- Arteriodilation (high doses)
Only nitrite compound used to treat angina.
Amyl Nitrite
Volatile liquid administered by inhalation.
Amyl Nitrite
Most rapid onset (in 30 sec.) and has the shortest DOA.
Amyl Nitrite
▪ Treatment of acute angina attacks.
▪ Initial treatment of cyanide poisoning.
Amyl Nitrite
▪ Sublingual → acute angina attacks
▪ Oral (SR) and transdermal → prevention of angina attacks
▪ Intravenous → AHF associated with angina and MI
Nitroglycerin
Sublingual & oral for both preventive and treatment of angina attacks
ISDN (Isosorbide dinitrate)
Beta Blockers drugs
• ATENOLOL
• PROPRANOLOL
• METOPROLOL
Brand name of ATENOLOL
Tenormin
Brand name of PROPRANOLOL
Inderal
Brand name of METOPROLOL
Lopressor
Only used in the maintenance therapy and prophylaxis of exertional angina
Beta Blockers
Prevent reflex tachycardia
Beta Blockers
Increases patient survival after MI
Beta Blockers
CALCIUM CHANNEL BLOCKERS drugs
Non-DHP CCBs ( Non-dihydropyridine )
•Diltiazem
•Verapamil
DHP (Dihydropyridine) CCBs drugs
nifedipine, isradipine, felodipine, nicardipine, nisoldipine, lacidipine, amlodipine, and levamlodipine
Brand name of Ranolazine
Ranexa
Brand name of Trimetazidine
•Vestar
• Vastarel
Inhibits ketoacyl-CoA thiolase, the key enzyme in the beta-oxidation pathway of fatty acid metabolism.
Trimetazidine
The effect of this drug is the reduction of fatty acid oxidation evokes compensatory increase in glucose metabolism. Glucose metabolism reduces oxygen consumption by 20%.
Trimetazidine
Blocks the pathological activation or prolongation of the late inward sodium current (INa-L) in heart cells that leads to excessive intracellular sodium and calcium accumulation. Increase in intracellular calcium can lead to mechanical dysfunction, abnormal contraction and relaxation, electrical instability, afterdepolarizations, and arrhythmia.
Ranolazine
It has shown to increases exercise capacity in patients with angina resulting to fewer anginal symptoms and decreased need for NTG use.
Ranolazine
