N304 Antianginal Agents

increase blood flow to ischemic heart muscle and/or decrease myocardial oxygen demand

• 1. Nitrates
• 2. Beta- blockers
• 3. Calcium channel blockers

• - cause vasodilation due to relaxation of smooth muscles
• - potent dilating effect on coronary arteries
• - used for prophylaxis and treatement of angina

nitroglycerin

• large first-pass effect with PO forms
• used for symptomatic treatment fo ischemic heart conditions (angina)
• •IV form used for BP control in perioperative hypertension, treatment of CHF, ischemic pain, and pulmonary edema associated with acute MI

• HA (b/c the blood vessels were dilalated)
• flushing of face
• tachycardia, postural hypotension
• tolerance may develop-- mostly with transdermal

• with Ca++ blockers
• with beta blockers
• ETOH
• Viagra -- may lead to fatal hypotension

• •isosorbide dinitrate -
• (Isordil, Sorbitrate, Dilatrate SR)

• •isosorbide mononitrate –
• (Imdur, Monoket, ISMO)

• Nitrate
• Names:
• Isordil, Sorbitrate, Dilatrate SR

• Nitrate
• Names:
• Imdur, Monoket, ISMO

• •Acute relief of angina-- (sublingual, but not
• PO—po takes too long)

• •Prophylaxis
• (PREVENT! ) in situations that may provoke angina

• •Long-term
• prophylaxis of angina

blocks the myocardium itself. Slows rate adn contractility. Decreases demand adn increases delivery to the heart.

• •Decrease the HR, resulting in decreased myocardial oxygen demand and increased oxygen
• delivery to the heart

•Decrease myocardial contractility, helping to conserve energy or decrease demand

• Antianginal
• Antihypertensive
• Cardioprotective effects, especially after MI

bradycardia, hypotension, 2nd or third decress heart block, HF

altered glucose and lipid metabolism

dizziness, fatigue, mental depression (elderly), lethary, drowsiness, unusual dreams

impotence (dec. libido) wheezing, dyspnea

• –Diuretics--additative
• –Antihypertensives
• –Phenothiazines- pheragan, composanine…
• –Anticholinergics
• –Insulin & oral hypoglycemics
• •Sx of hypoglycemia

-olol

• atenolol (tenormin)
• metoprolol (lopressor)
• Propanolol (Inderal)
• Nadolol (Corgard)

• b.blocker
• post-MI patients. Selective Beta 1

• b.blocker
• short AND longacting

• b.blocker
• non-selective, most lipid soluble, works well to prevent migranes (gets over BB barrier). Many asians lack the enzyme to metabolize this.

• b.blocker
• non-selective

• –Monitor HR & BP- soon before giving the drug.
• –Safety- can have dizziness (CNS rxn)
• –Blood sugar
• –Lung sounds
• –Taper to stop

–COPD, asthma, decompensated HF, arrhythmias

• •Cause peripheral arterial vasodilation
• •Reduce myocardial contractility
• (negative inotropic action)
• •Depress SA & AV nodes
• •Result: decreased myocardial oxygen demand

Dihydropyridines and nondihydropyridines.....

• CCB
• work in arterial smooth muscle
• Tx HTN adn angina, prevent angina
• Drugs-- end in "pine"

• •nifedipine [adalat, Procardia] – po- oldest one
• •amlodipine [Norvasc] -
• •isradipine [DynaCirc] – most potent
• •nicardipine [Cardene]
• •nisoldipine [Nisocor]

• SE: flushing, HA, hypotension, peripheral edema (all bc of vasodilation....expected)
• Interactions: B. BLOCKERS, digoxin, grapefruit juice

• CCBs
• Uses- HTN, angina, dysrhymias
• Drugs:
• •Diltiazem [Cardizem]
• •Verapamil [Calan, Isoptin]

negative inotrophic (heart muscle) and chronotrophic (Heart beat)

• •SE
• –Flushing, HA, dizziness, peripheral edema
• –Constipation- common
• –Dysrhythmias
• –Confusion, drowsiness, mood changes (elderly)

• •Interactions
• –Digoxin
• –Antihypertensives
• –Statins (DO NOT GIVE WITH!)- very severe rxn. Muscle injury. Myopathy. See them degenerate.
• –Grapefruit juice

NO! it is just a drug that we take everyday to prevent angina