Anti anginal Drugs

Angina:Medical term for ischemiac chest pain.

Types of Angina
1. Atherosclerotic Angina
2. Vasospastic Angina
3.Unstable Angina
MYOCARDIAL OXYGEN
O2 DEMAND SUPPLY TO
HEART

Angina occurs due to imbalance between heart oxygen

supply and oxygen demand.
Drugs used in angina exploit two main strategies.
1.Reduction of oxygen demand
2. increase oxygen delivery.
 NITRATES AND NITRITES
ORGANIC NITRATES:
 NITRO GLYCERINE
 ISOSORBIDE DINITRATE
 ISOSORBIDE MONONITRATE
MECHANISM OF ACTION
Effects
- Relaxation most of smooth muscle

- Dilatation of the veins predominates over that of arterioles

- Decrease of preload

- Systemic arterial pressure may fall slightly, and heart rate is unchanged or
slightly increased reflexly.

SIDE EFFECTS
 HYPOTENSION
 TACHYCARDIA
 HEADACHE
 FACIAL FLUSHING

BETA BLOCKERS

MECHANISM OF ACTION
 Beta blockers work by blocking the effects of the hormone
epinephrine, also known as adrenaline.
Beta blockers cause your heart to beat more slowly and with
less force, which lowers blood pressure. Beta blockers also
help open up your veins and arteries to improve blood flow.
EFFECTS:
BETA BLOCKER DECREASE HEART RATE AND FORCE SO
REDUCE CARDIAC OUTPUT AND BLOOD PRESSURE SO
WORK LOAD ON HEART WILL DECREASE.
CALCIUM CHANNEL BLOCKERS

ADVERSE EFFECTS:
 BRADYCARDIA
 HYOTENSION
 FATIQUE
 INSOMNIA
 SEXUAL DYSFUNCTION

 CALCIUM CHANNEL BLOCKERS
DIHYDROPYRIDINES:
 AMLODIPINE
 NIFEDIPINE
 FELODIPINE
NON DIHYDROPYRIDINES:
 DILTIAZEM
 VERAPAMIL
MECHANISM OF ACTION
CALCIUM CHANNEL ANTAGONIST BLOCK THE INWARD
MOVEMENT OF CALCIUM BY BINDING TO L –TYPE
CALCIUM CHANNEL IN THE HEART AND IN SMOOTH
MUSCLE OF CORONARY AND PERIPHERAL ARTRIOLAR
VASCULATURE.
 Therapeutic uses
• Hypertension
• Angina pectoris
• Cardiac failure
• Dysrhytmias

ADVERSE EFFECTS :
 FLUSHING
 DIZZINESS
 HEADACHE
 HYPOTENSION
 PERIPHERAL EDEMA

RENOLAZINE
• Ranolazine represents a new class of antianginal drugs.
• By blocking late inward sodium currents, calcium
overload and diastolic wall stress are reduced, leading to
improved coronary blood flow.
• Partial fatty oxidation inhibitor
This agent is likely to become standard therapy for chronic
stable angina and may play a future role in the management
of acute coronary syndromes
 Anti hypertensive drugs
Hypertension:
Hypertension is defined as
sustained
Diastolic pressure >90 mm hg
Systolic pressure > 190 mm hg
Hypertension is of two types
1- primary hypertension
2- secondary hypertension
Patients with primary hypertension are generally
treated with drugs that 1) reduce blood volume
(which reduces central venous pressure and cardiac
output), 2) reduce systemic vascular resistance, or
3) reduce cardiac output by depressing heart rate
and stroke volume. Patients with secondary
hypertension are best treated by controlling or
removing the underlying disease or pathology,
although they may still require antihypertensive
drugs
Drugs used in hypertension are :
 Diuretics
Diuretics lower blood pressure by reduction of
blood volume and probably also by a direct
vasodilating effect.
Diuretics used for treating hyper tension are
1.Thiazides
2.Loop diuretics
3.Potassium sparing diuretics
Thiazides diuretics : used for mild to
moderate hypertension in normal and
cardiac function
Loop diuretics : used for severe
hypertension in renal insufficiency, cardiac
failure and cirrhosis.
Potassium sparing diuretics: are
sometimes used in combination with loop
and thiazides to reduce the amount of
potassium loss induced by these diuretics.
Side effects:

1.thiazide diuretics can induce

hypokalemia, hyperuricemia and to a
lesser extent hyperglycemia in some
patients,hypovolemia and metabolic
alkalosis.
2.Loop diuretics can cause hypokalemia,
increase calcium content of
urine,metabolic alkalosis and
hypovolemia.
3.Potassium sparing diuretics can cause
hyperkalemia,metabolic acidosis,gastric
problems including peptic ulcer.
 Sympathoplegics
Includes
 Centrally acting adrenergic drugs
 Ganglia blockers
 Nerve terminal blockers
 Alpha and beta blockers

Centrally acting alpha 2 agonist

Centrally acting alpha2 agonist includes
Clonidine and methyldopa

1 clonidine: clonidine acts as an alpha2 agonist to produce

inhibition of sympathetic vasomotor centres decreasing
sympathetic outflow
to periphery.
This leads to reduce total peripheral resistance and
decrease b.p
Adverse effects:
Sedation,dry mouth and constipation ,bradycardia

Methyldopa
Methyldopa is also an alpha 2 agonist that is converted
centrally to methlnorepinephrine to diminish
adrenergic outflow from cns. side effects includes
sedation and drowsiness, positive comb’s test,
constipation and nausea.

Adrenergic blockers
Adernergic blockers includes
 Alpha blockers
 Beta blockers

Alpha blockers
Alpha blockers blockes (prazosin ,terazosin and
doxazosin) includes produce competitive block of
alpha 1 adrenoreceptors decreasing peripheral
vascular resistance and b.p
Reflex tachycardia and postural hypotension occurs at
onset of treatment.

Beta blockers
Beta blockers includes
Propanolol
Metoprolol
Atenolon
Nebivolol
Mechanism: beta blockers blocks beta 1 receptors
at heart decreasing cardiac output and b.p.
Uses:
Beta-blockers are used for treating hypertension, angina,
myocardial infarction, arrhythmias and heart failure.

Adverse effects:
 Hypotension
 Bradycardia
 Fatique
 Insomnia
 Sexual dysfunction
Contraindications:
Asthma, second and third degree heart block acute
heart failure and severe peripheral vascular disease.

ACE inhibitors
Includes:
 benazepril
 captopril
 enalapril
 fosinopril
 lisinopril
 moexipril
 quinapril
 ramipril
Mechanism:
ACE inhibitors produce vasodilation by inhibiting the
formation of angiotensin II.
Uses:
hypertension
ACE inhibitors are considered "first-line therapy" in the
treatment of stage 1 hypertension. They may also be used in
hypertension caused by renal artery stenosis.

Heart failure:
ACE inhibitors have proven to be very effective in the
treatment of heart failure caused by systolic dysfunction.

Myocardial infarction and

Chronic renal disease

Side effects :
Dry cough
Hyperkalemia
Skin rash
Angioedema
Hypotension
Altered taste
  ACE INHIBITORS CONTRAINDICATED IN
PREGNANCY.

ANGIOTENSIN II RECEPTOR BLOCKERS

LOSARTAN
IBESARTAN
AZILSARTAN
EPROSARTAN
 BLOCKS ATII RECEPTORS CAUSING VASODILATION AND
BLOCKS ALDOSTERONE RELEASE .
 ADVERSE EFFECTS ARE SIMILAR TO ACE INHIBITORS BUT
RISK OF ANGIOEDEMA AND COUGH IS SIGNIFICANTLY
DECREASED.
 SHOULD NOT BE GIVEN WITH ACE INHIBITOR.

RENIN INHIBITOR
 ALISKREIN
Newer drug in anti hypertensive group blocks renin’s action
on it’s substrate
 Toxicity includes headache and diarrhea.

Calcium channel blockers

Includes dihydropyridines and non dihydropyridines

Dihydropyridines include the following specific drugs: 

  amlodipine
 felodipine
 isradipine
 nicardipine
 nifedipine
 nimodipine
 nitrendipine

Nondiydropyridines includes verapamil and

dilitiazem.
Mechanism:
Currently approved calcium-channel blockers (CCBs) bind to
L-type calcium channels located on the vascular smooth
muscle, cardiac myocytes, and cardiac nodal tissue (sinoatrial
and atrioventricular nodes).

Theraputeic uses:
 hypertension
 angina
 arrhythmias
side effects :
Dihydropyridine CCBs can cause flushing, headache,
gingival hyperplasia, excessive hypotension, edema and
reflex tachycardia.
First degree heart block and constipation are common
side effects of verapamil.
 Verapamil and dilitiazem should be avoided in
patients with heart failure and av block .
THE END