Cardio: Anti-anginal Drugs Flashcards Preview

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Flashcards in Cardio: Anti-anginal Drugs Deck (13)
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1

  • Phenylalkylamine
  • L-type Calcium channel blocker
  • Cause Coronary Vasodilation and Relief of Spasm
  • Slowed Conduction through the AV Node
  • May produce AV block when used in combination with β-adrenoceptor antagonists
  • Produces peripheral vasodilating effects --> reduce afterload and blood pressure
  • Cause, Headache, reflex Tachycardia, Fluid retention

Verapamil (Calan, Isootin, Verelan)

2

  • Dihydropyridines calcium channel blockers
  • Predominant actions in the Peripheral vasculature
  • Decrease Afterload
  • Small-decrease in Preload
  • Lowers Blood pressure
  • Significantly less direct effect on the heart than Verapamil

Nifedipine (Adalat)

Nimodipine

Isradipine

Amlodipine

Felodipine

Nisoldipine

3

  • Benzothiazepine Ca2+ Channel blocker
  • Treats Prinzmetal angina

Diltiazem (Cardizem)

4

Drugs capable of denitration to release Nitric oxide (NO)

Nitroglycerin (Nitrol, Nitrostat)

Isosorbide dinitrate (Isordil)

Isosorbide-5-mononitrate (Imdur)

Amyl Nitrate

Erythrityl tetranitrate (Cardilate)

5

Mechanism of Action for Nitric oxide (NO)

  • Nitroglycerin releases NO to activate Guanylyl cyclase
  • Leads to the formation of cGMP and activation of cGMP-dependent kinases
  • cGMP activates Myosin light chain phosphatase to Dephosphorylate myosin light chain
  • Leads to the uncoupling of Myosin and Actin in Smooth muscle cells and thus Vasodilation in Arterioles and particularly in Venules (All vessels)

6

(4) Ways NO reduces Angina

  1. Dilation of Systemic venules to decrease the Preload
    → Increase the pressure gradient from the Aorta to the endocardium
    → Increase Coronary blood flow
  2. Reduction in Preload reduces the oxygen demand
  3. Dilation of the Coronary epicardial vessels only, NO Coronary Steal effect
  4. Modest declines in SBP (afterload) are useful in decreasing oxygen consumption

7

NO is used in the treatment of:

  • Angina
  • Congestive heart failure
  • MI

8

NO is contraindicated in pts. w/

  • Patients taking Sildenafil (Viagra)
  • Hypotension
  • Hypertrophic obstructive cardiomyopathy
  • Diastolic heart failure

9

Side effects of NO use:

  • Heart failure
  • AV block
  • Bradycardia
  • Cardiac arrest
  • Cardiac depression
  • Orthostatic Hypotension
  • Reflex Tachycardia
  • Headache
  • Blushing
  • (High dose) Methemoglobinemia and cyanosis

10

β-Adrenergic receptor antagonists: 
β-blocker drugs

  • Non-selective β-blockers
    • Propranolol (Inderal)​
    • Sotalol
    • Pindolol (Visken)
  • β1-selective blockers
    • Atenolol (Tenormin)
    • Acebutolol
    • Bisoprolol

11

Mechanism of action of β-blockers

  • Reduce the Heart rate (via automaticity and conduction velocity) to decrease the myocardial O2 consumption
  • Reduce Heart contractility to decrease the myocardial O2 consumption
  • Reduce the Arterial blood pressure to decrease the myocardial O2 consumption

12

Side effects of β-blockers:

  • Asthma
  • Erectile dysfuntion
  • Depression
  • Insomnia
  • Contraindicated in Bradycardia, AV block, and Asthma

13

  • Non-nitrate coronary vasodilator that interferes with uptake of Adenosine (vasodilator)
  • Potentiates the effect of PGI2 (Prostacyclin, Epoprostenol) and dilates Resistance vessels and inhibits Platelet aggregation
  • Prophylaxis of Angina Pectoris
  • Causes, possible worsening of Angina, Dizziness, and Headache

Dipyridamole (Persantine)