Drug Classification

Anti-Anginal Drugs
 What is Angina??
Angina is a characteristic chest pain that occurs due to
an imbalance between oxygen supply and oxygen
demand of the myocardium

Stable Angina
Obstruction of blood vessels

Prinzmetal Angina
Spasm of vascular smooth
muscles

Unstable Angina
More frequent pain
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 O2
Supply
O2
Demand

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 Risk Factors for CVS Diseases
Modifiable Non-modifiable
Smoking
Personal history of
Hyperlipidaemia CHD
Hypertension Family history of CHD

Diabetes mellitus Age

Obesity
Gender
Dietary factors
Lack of exercise
Excess alcohol consumption
 Non -Pharmacological Treatment
Work on Modification of Risk Factors

Pharmacological Treatment
•Anti-platelets: Aspirin
•Anti-anginal Drugs (3 Classes)

Calcium
Nitrates β Blockers Channel
Blockers

Act generally to improve the balance of myocardial oxygen

supply and demand.
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I. Organic Nitrates
 MOA
1. Administered nitrates

2. Intracellular conversion to nitrites

3. Conversion into nitric oxide (NO)

4. Relaxation of vascular smooth muscle

5. Vasodilation
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 1. Nitroglycerin (GTN/NTG)

This is the drug of choice

to relieve an ongoing attack of angina
caused by
excessive exercise
or

emotional stress.

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 Effects of Nitrates on the CVS

Dilation of blood vessels

resulting in pooling of
blood in the veins
Dilation of coronary
vasculature providing higher
Decrease workload blood supply to the cardiac
on the heart muscle

Nitroglycerin decreases myocardial oxygen demand by decreasing workload

on the heart & increasing blood supply to the myocardium.
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Pharmacokinetics
Rapid onset around 1 minute,
therefore useful for anginal attacks
Given as:
a. Sublingual Question:
b. Spray Why is it not giving orally??
c. Transdermal patch
d. Solution for Infusion Answer:-----------------------
 Adverse Effects

• The most common adverse

effect is:
a. Headache (30 to 60% of patients)
b. Postural hypotension
c. Facial flushing

• High doses of organic nitrates

cause:
Tachycardia
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 II. Beta Adrenergic Blockers
• Blocks β1 receptors on the heart

• Decrease workload of the heart by reducing:

✓ Heart rate
✓ Force of cardiac contraction
✓ Cardiac output
✓ Blood Pressure

• Β blockers are not useful in prinzmetal angina.

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 II. Beta Adrenergic Blockers
Prototype is PROPRANOLOL but it is non-cardioselective.

Other useful drugs:

- ATENOLOL
- METOPROLOL
 III. Calcium Channel Blockers
• Refer to previous slide on CCB
•Calcium is necessary for muscular contraction.

• Calcium channel blockers inhibit the entrance of calcium into

the smooth muscle cells of coronary and systemic arteries
(increase Oxygen supply and reducing oxygen demand)

• All CCB lower BP

• All of the CCB should be avoided in CHF due to their negative

inotropic effect
 A 56 – year old patient complains of chest pain following any
sustained exercise. He is diagnosed with atherosclerotic angina.
He is prescribed sublingual nitroglycerin for treatment of acute
chest pain.

1. Which of the following adverse

effects is likely to be experienced
by this patient?
a. Hypertension
b. Throbbing headache
c. Bradycardia
d. Sexual dysfunction
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 Cardiac Medications

Antiarrythmic Antihypertensive Antianginal

Drugs used in
Congestive Heart Hyperlipidemias
Failure