ANTI ANGINA THERAPY
Angina Pectoris : Mismatch between myocardial oxygen supply
and demand.
Symptom: Retrosternal discomfort, pressure like, occurs with exertion, relieved by rest, may radiate down arm or into neck.
Drug Mech of action/ indication
Organic nitrates: decompose to NO  activate
guanylate cyclase, so 
1)nitorglycerin cGMP, cGMP activate
2)isosorbide dinitrate protein kinase, lead to 
3)isosorbide-5- intracellular Ca. in smooth
mononitrate
muscle, reduced
phosphorylation of myosin
light chain, reduced calcium,
Method of and relaxation.
administration :
At concentration, nitrates
a)sublingual= decrease preload, so reduce
nitoglycerin workload on heart.
At  concentration, nitrate
b)oral = isosorbide cause vasodilaton of coronary
dinitrate A and blood supply to
myometrium
c)cutaneous = I – angina, MI, heart failure
transdermal patch
d)IV
-blocker: - block action of NA n
Adrenaline at beta adrenergic
receptor
Metabolism/ drug Side effect/ contraindication Clinical use
interaction
A)Tolerance -Headache, = stable angina
=continue exposure to - hypotension, = unstable angina
nitrates leads to decrease -transiet of hypotension worsen = MI
magnitude of with alcohol
= HF
pharmacological effect.
=due to decrease in free – = hypertensive
SH group
require nitrate free 24-h
B) Interaction with
Phosphodiesterase 5
inhibitors:
- sildenafil (viagra)
-taldalafil (cialis)
-vardenafil (levitra)
combination of nitrates
with this drug causes
extreme hypotension
-bronchoconstriction (block = angina stable
beta 2 mediated smooth muscle = MI
relaxation) = HF
Non selective: -reduce mortaliti and -mask symptom of = arrythmias
1) propanolol, infarction hypoglycemia
2) timolol -reduce myocardial O2 -HF
demand by: -bradycardia
Cardioselective: a) HR -somnolence(induce sleep)
1)Metaprolol b) BP (afterload) -depression
2)Atenolol c) contarctility -impotence

Alpha 1 antagonist xtvt:

1)carvedilol Result =
1-heart ratecontractility
2- contract SM (blood vessel
and bronchi)
1- smooth muscle relaxation
Ca channel blocker - Block L-type calcium Headache, dizziness =arrythmias
channels, so Ca entry, so Flushing = hypertension
Dihydropyridine: intracellular Ca Oedema = chronic stable angina,
1)nifedipine Tachycardia
not used in unstable
2)amlodipine - In SMOOTH muscle = Constipation
=affect vasculature Hypotension angina
vascular smooth muscle
(decrease BP) relaxation
- in HEART = contractility
Non Dihydropyridine;
1)verapramil -can alter ratio of O2
2)diltiazem supply/demand in CHRONIC
=affect heart (decrease STABLE ANGINA:
HR) a) arteriolar Pressure
b) myocardial contractility
c) HR
Gene therapy  new vessel formation
(eg:VGEF)