Pharm II (Antianginal drugs) 1a

• 1.Functional end arteries
• 2.Maximum oxygen extraction (low O2 concentration in venous blood)
• 3. Increased blood flow during diastole (enters through the coronary arteries)

Printzmetals Variant angina (Beta Blockers can causes a small vasoconstriction, thus they are contraindicated here)

Chronic Stable Angina (AKA Angina Pectoris or Angina of effort)

Unstable Angina-

• -Coronary Vasodilators--- Ca++ entry blockers
• -Anti-thrombotic drugs
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• -Vasodilators--- Organic Nitates and Ca++ entry blockers
• -Cardiac depressents- Beta blockers

-NITRATES

-BETA BLOCKERS

-CALCIUM CHANNEL BLOCKERS

----OTHERS : Ranolazine, Trimetazidine, Nicorandil

• 1.Isosorbide dinitrate
• 2.Nitroglycerine
• 3.Isosorbide mononitrate
• 4.Amyl nitrite

They release NO--> which increases cGMP concentrations--> leading to vasodilation.

- Fastest action if given Sublingually, because it is LIPID SOLUBLE and can cross through membranes fast, and does NOT pass the liver circulation.

• Systemically:
• -Vasodilation
• Cardiac:
• -Reduces preload and afterload
• -Decreases oxygen demands
• Coronary:
• -Prevents vasospasm
• -Improves subendocardial perfusion-- helps develope colateral blood supplies
• -Increases Oxygen delivery

• -Nitrates are denitrated by glutathione reductase
• -Denitrated metabolites are less active but longer acting.

• throbbing headache--inclination that drug is working
• methemoglobinemia-- Fe3+--losses its O2 carrying capasity. If it gets too high can lead to cyanosis and ischemia. Has a higher affinity for Cyanide.
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• Tolerance-- activation of thimpathietics and volume expansion. This decreases Nitrates effect. Prevent with NItrate free periods (10-12 hours)

• -Angina
• -CCF and LVF
• -Cyanide poisoning (Nitrites)
• Methemoglobin binds CN- --> Cyanomethemoglobin treat with Sodium Thiosufate that takes Cyanomethemoglobin to methemoglobin and Sodium ThioCN

Atenolol, metoprolol and propranolol


-Decrease contractility, heart rate, conduction velocity

-Causes smooth muscle contraction ( and a mild vasoconstriction )

Feeling of coldness in the extremities

they decrease the workload on the heart and reduce the hearts response to excersize