This document discusses angina pectoris, including its causes, risk factors, classifications, and treatments. Angina is chest pain due to an imbalance between myocardial oxygen demand and supply. It is classified into four types based on triggers and severity. Treatment includes short-acting nitrates for acute attacks and long-acting options like nitrates, calcium channel blockers, and beta-blockers for prophylaxis. Additional therapies discussed are potassium channel openers, fatty acid oxidase inhibitors, and antiplatelets/anticoagulants. Combination drug regimens and surgical options are also outlined for management of angina.
6. Nitrates&Nitrites
Preparations :
1- Short acting:
Start within few minutes and total
duration of action 15-30 minutes.
A) Nitroglycerine (Glyceryl trinitrate)
Used as sublingual tablets.
B) Isosorbide dinitrate
As sublingual spray.
C) Amyl nitrite
Inhalation
7. Continue
2- long acting
Nitroglycerine, Isosorbide
dinitrate,Isosorbide mononitrate.
Delayed onset of action and continue
for hours .
Given : Orally,Ointment,Transdermal
patch, Intravenous.
9. Continue
Metabolism
Through first pass hepatic metabolism.
Short acting not given orally to avoid first
pass metabolism.
Nitroglycerine & Isosorbide dinitrate have
active metabolites.
12. Pharmacologicalactions
Nitrates relax all types of smooth muscles
vascular or non vascular .
Potent venodilator.
Have no effect on cardiac or skeletal
muscles.
NO released stimulate guanylyl cyclase
in platelets causing increase cGMP that
decrease platelet aggregation.
13. Clinicaluses
Effective in all types of angina:
Short acting for acute attacks
Long acting for prophylactic.
Severe heart failure.
23. Clinicaluses
In all types of angina but very
effective in variant angina .
Used in prophylactic therapy.
Hypertension
Supraventricular tachycardia
Peripheral vascular disease
26. β-Adrenoceptor blockingdrugs
Not vasodilators
Used in prophylactic treatment of
angina through :
Decrease in both heart rate &
myocardial contractility that
decrease myocardial oxygen
requirement at rest & in exercise so
improve exercise tolerance.
27. Continue
Effective in the prophylactic treatment of
all types of angina Except in
variant angina.
Decrease mortality of patients with recent
myocardial infarction, heart failure &
hypertension.
28. Potassiumchannelopeners
Activation of potassium channels.
Nitric oxide release.
Arterio & venodilator.
Used as prophylactic therapy .
Side effects : Headache, flushing,
dizziness.
Nicorandil
29. FattyAcidOxidaseInhibitors
Oxidation of fatty acids as a source of energy
needs more oxygen than oxidation of
carbohydrate.
Drugs that shift myocardial metabolism
toward use of glucose (fatty acid oxidase
inhibitors) have the potential of reducing the
oxygen demand without change
hemodynamics , e.g. trimetazidine