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lect-anian

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lect-anian

  1. 1. Antianginal Drugs Garrett J. Gross
  2. 16. Myocardial Preconditioning <ul><li>Single or multiple brief periods of ischemia result in a marked reduction in infarct size when the hearts are exposed to a more prolonged period of ischemia. </li></ul><ul><li>Has 2 phases:Acute and Delayed PC </li></ul><ul><li>Acute phase lasts 1-2 Hours </li></ul><ul><li>Delayed phase lasts 24-72 Hours </li></ul><ul><li>Nitrogycerin(GTN) produces delayed PC in animal and clinical studies. </li></ul><ul><li>This effect persists even in the presence of tolerance to its vasodilator effects </li></ul>
  3. 17. &quot; Decrease in the effect of a drug when administered in a long-acting form&quot; NITRATES TOLERANCE Develops with all nitrates Is dose-dependent Disappears in 24 h. after stopping the drug Tolerance can be avoided - Using the least effective dose - Creating discontinuous plasma levels
  4. 19. NITRATES CONTRAINDICATIONS Previous hypersensitivity Hypotension ( < 80 mmHg) AMI with low ventricular filling pressure 1 st trimester of pregnancy WITH CAUTION: <ul><li>Constrictive pericarditis </li></ul><ul><li>Intracranial hypertension </li></ul><ul><li>Hypertrophic cardiomyopathy </li></ul>
  5. 21. ß-ADRENERGIC BLOCKERS CONTRAINDICATIONS Hypotension: BP < 100 mmHg Bradycardia: HR < 50 bpm Chronic bronchitis, ASTHMA Severe chronic renal insufficiency
  6. 24. Reasons for Using Nitrates and Beta Blockers in Combination in Angina <ul><li>Beta Blockers prevent reflex tachycardia and contractility produced by nitrate-induced hypotension. </li></ul><ul><li>Nitrates prevent any coronary vasospasm produced by Beta Blockers. </li></ul><ul><li>Nitrates prevent increases in left ventricular filling pressure or preload resulting from the negative inotropic effects produced by Beta Blockers. </li></ul><ul><li>Nitrates and Beta Blockers both reduce myocardial oxygen consumption by different mechanisms. </li></ul><ul><li>Nitrates and Beta Blockers both increase subendocardial blood flow by different mechanisms </li></ul>

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