P H A R M A C O LO G Y

Anti-AnginalD rugs

Angina= a condition marked by

severe pain in the chest, often also
spreading to the shoulders, arms,
and neck, caused by an inadequate
blood supply to the heart.

Anantianginalis anydrugused in
the treatment ofangina pectoris, a
symptom ofischaemic heart disease.
 Angina Pectoris is the medical term
for chest pain or discomfort due to
coronary heart disease. It occurs
when the heart muscle doesn't get
as much blood as it needs. This
usually happens because one or
more of the heart's arteries is
narrowed or blocked, also called
ischemia.
 Coronary = relating to or denoting
the arteries that surround and supply
the heart.

Unstable anginais a condition in

which your heart doesn't get enough
blood flow and oxygen
 Prinzmetal'sorPrinzmetal angina (also
known asvariant
angina,vasospasticangina(VSA),anginainvers
a, or coronary vessel spasm) is a syndrome
typically consisting ofangina(cardiac chest pain)
at rest that occurs in cycles.

Stable anginais chest pain or discomfort

that most often occurs with activity or
emotional stress.Anginais due to poor blood
flow through the blood vessels in the heart.
 Vasospasmrefers to a condition in
which an arterial spasm(a sudden involuntary
muscular contraction or convulsive movement) leads to

vasoconstriction
D rug Classes

Long-acting nitrates
Calcium channel blockers
-blockers
Ivabradine
Trimetazidine
D rug Classes

-blockers: make the heart beat slower

with less force. That means the heart
needs less blood and oxygen after
exercise, which can either prevent
angina or reduce the frequency of
attack. Examples are propranolol,
atenolol, metoprolol, carvedilol, etc.
 They are also contraindicated in
severe asthmatics due to
bronchoconstriction, and should be
used cautiously in diabetics as they
can mask symptoms of
hypoglycemia.
 Aninotrope[help 1]is an agent that
alters the force or energy of
muscular contractions. Negatively
inotropic agents weaken the force of
muscularcontractions. Positively
inotropic agents increase the
strength of muscular contraction.
 Chronotropic drugs- may change
heart rate and rhythm by affecting
electrical conduction system of the
heart and the nerves that influence it
such as changing the rhythm
produced by the sunoatrial node.

Positive chronotropes increases heart

rate.
Negative Chronotropes decreases
heart rate.

Calcium channel blockers: relax the
muscles that make up the walls of
your arteries, increasing the blood
supply to the heart. Examples are
amlodipine, diltiazem, felodipine,
nifedipine, verapamil, etc.
 Calciumion(Ca++) antagonists (
Calcium channel blockers) are used in
the treatment of chronic stable
angina, and most effectively in the
treatment of variant angina (directly
preventing coronary artery
vasospasm). They are not used in the
treatment of unstable angina .
 In vitro, they dilate the coronary and peripheral
arteries and have negativeinotropicand
chronotropiceffects - decreasingafterload,
improving myocardial efficiency, reducing
heart rateand improving coronary blood flow.In
vivo, the vasodilation andhypotensiontrigger
thebaroreceptorreflex. Therefore the net effect
is the interplay of direct and reflex actions.

Examples include Class I agents (e.g.,verapamil

), Class II agents (e.g.,amlodipine,nifedipine),
or the Class III agentdiltiazem.
 Ivabradine: selective sinus node If
inhibitor, with effect similar to -
blocker slows down the speed of
your heart beat. Often used in
patients unable to take -blockers for
medical reasons.
 glyceryl trinitrate(GTN)=also
known asglyceryl trinitrate(GTN)
is a medication used forheart failure
,high blood pressure, and to treat
and prevent
chest pain from not enough blood flo
w to the heart
. This includes chest pain due to
cocaineand from aheart attack. It is
taken by mouth, under the tongue,
applied to the skin, and by
Common side effects and precautions