ANTIANGINAL

DRUGS
• Angina pectoris
• Is a chest pain due to decreased blood flow to the heart or due
to an inadequate supply of oxygen to the heart muscle? The pain is
typically severe and crushing, and it is characterized by a feeling of
pressure and suffocation just behind the breastbone. Angina can
accompany or be a precursor of a heart attack .Shiel, W,(Jr) 2017
2 main types of angina
• 1. Exertional angina-caused by increased physical exertion
-Also called chronic stable angina
-also called classic angina, typical and effect -induced
-Most common type
-due to atherosclerosis of the coronary artery
 
• 2.Vasospastic angina-caused by vasospasm of the coronary
artery
-Also called rest angina, variant, Prinz metal
 
• Strategy Treatment (Therapeutic goals)
1. Increase O2 delivery- Nitrates, Vasodilators, Ca blockers
2. Decrease O2 demand-B- blockers, Ca blockers
• ANTIANGINAL DRUGS
• 1.Nitrates
Nitroglycerin –is the most widely used drug of this class
Routes are SL /buccal/ spray nitroglycerin, patch
ISDN –( Isosorbide dinitrate) SL/ Oral
ISMN- ( Isosorbide mononitrate) Oral 

MOA of nitrates
-converted to nitric oxide (NO)---this increase cGMP-----smooth
muscle relaxation----vasodilation----venodilation and arterial
dilation---decrease oxygen demand---therefore dilation of coronary
artery.

 
• For Acute attack
Nitroglycerin-SL/ buccal / Spray
ISDN –SL
• For Prophylaxis
Nitroglycerin-patch
ISDN-oral
ISMN-oral 
• Note:
-The nitrates undergo extensive first pass metabolism
-Tolerance (have 8-12-hour nitrate free interval)
 
• S/E: postural hypotension; reflex tachycardia, headache, flushing