NITRATES Releases NO within the smooth Acute Angina Tachycardia

muscles through enzyme aldehyde Acute coronary syndrome Orthostatic hypotension

dehydrogenase 2, increase cGMP, Headache
Short acting
vasodilation
Nitroglycerin, SL
Reduced cardiac work, double product
Isosorbide dinitrate, SL
and oxygen demand

Rapid onset: 1 min

DOA: 15 mins
Intermediate acting
Slow onset Prophylaxis of angina Same as nitroglycerin SL
Nitroglycerin, Oral DOA: 2-4 hours
Isosorbide dinitrate and mono nitrate,
Oral
Long acting Slow onset Prophylaxis of angina Tachyphylaxis
Long duration of absorption
Nitroglycerin, Transdermal patch DOA: 24 hours
Ultrashort acting Onset seconds Obsolete for angina Same as nitroglycerin SL
DOA: 1-5 mins Used for the treatment of cyanide
Amyl nitrite poisoning
CALCIUM CHANNEL Blocks L-typed Calcium channels Prophylactic for Angina (both Constipation
Reduced intracellular Calcium Atherosclerotic and Prinzmetal’s) Pretibial edema
BLOCKERS Reduced rate and contractility Hypertension Flushing
Reduced cardiac work, double product AV-nodal arrhythmias Higher doses: cardiac depression
Verapamil and oxygen demand
Diltiazem Severe atherosclerotic- combination of Serious:
calcium blockers + nitrates CHF
AV blockade
Sinus node depression
Dihydropyridines Blocks calcium channels Angina Like verapamil, less constipation
vascular > cardiac effect Hypertension
Nifedipine (rapid acting vasodilator) Cardiotoxic:
Prompt release, increase risk of MI
 Sudden reduction of BP, evokes
sympathetic outflow increasing HR and
contractility, these changes increases
the oxygen requirement. If the
coronary blood flow does not increase
sufficiently to meet the requirement, it
can lead to ischemia and infarction
BETA BLOCKERS Reduced cardiac work, double product Prophylaxis in effort of angina
and oxygen demand (ineffective in vasospastic angina)
Hypertension
Propranolol
OTHER ANTIANGINAL Blocks late sodium current in Angina QT prolongation on ECG
myocardium.
DRUGS Reduces cardiac work

Ranolazine Decrease in intracellular sodium,

increases calcium expulsion via Na/Ca
transporter
Ivabradine Blacks pacemaker sodium current in Angina
sinoatrial node, reduces HR CHF
PDE5 INHIBITORS Blocks Phosphodiesterase 5 Erectile dysfunction Interaction with nitrates
Increase cGMP Priapism
Sildenafil