Drugs used in ischemia (anti-anginal drug.pptx

Drugs used in ischemia (anti-anginal drug.pptx

• 1.
  ANTI-ANGINAL DRUGS
• 2.
  Introduction : • Anginapectoris is characterized by sudden severe pressing chest pain or heaviness radiating to the neck, jaw, back and arms. • It is often associated with diaphoresis, tachypnea and nausea. • Angina is caused by coronary flow that is insufficient to meet oxygen demands of the myocardium. There are three types of Angina : 1. Stable Angina ( Most common) 2. Unstable Angina 3. Prinzmetal (variant) angina
• 3.
  Stable Angina • Attacksare predictably provoked by exercise, emotion etc. It lasts for several seconds and subsides on rest. “Stable” indicates the reproducible nature of the angina; the same activity at the same intensity faithfully produces symptoms. Unstable Angina • The unstable angina is characterized by recurrent attacks of angina. It occurs with minimal exertion. It is precipitated due to combination of athero scleroti-plaque, platelet aggregation at ruptured plaque and vasospasm. Prinzmetal (Variant) Angina • This is a relatively uncommon pattern of myocardial ischemia usually occurring at rest or during sleep and often in young individuals. • It is induced by coronary artery vasospasm, it generally responds promptly to vasodilators.
• 4.
  ANTIANGINAL DRUGS: 1. Nitrates: •Glyceryl trinitrate (Nitroglycerin) • Isosorbide dinitrate, Isosorbide mononitrate 2. Beta-blocker • Atenolol, propranolol, metoprolol 3. Calcium channel blocker • Nifedipine, amlodipine 4. Potassium channel opener Nicorandil
• 5.
  NITRATES • They actdirectly on all the smooth muscle of the body & relax them. • Nitrates release nitric oxide which is a powerful muscle relaxants. • Most predominant in the vascular smooth muscles (i.e walls of arteries & veins). Preload reduction Nitroglycerin relaxes vascular smooth muscle and dilates both arterial and venous vessels. Dilation of veins is more predominant than dilation of arteries, resulting in peripheral pooling of blood & decreased venous return. decreased preload
• 6.
  Afterload reduction Nitrates alsoproduce some arteriolar dilatation Decrease peripheral resistance Reduction of afterload Redistribution of coronary flow Dilatation of coronary arteries Increase blood supply to the myocardium Effects on other smooth muscles • Relax the bronchi, biliary tracts & esophagus muscles. • Also dilates cutaneous vessels & meningeal vessels .
• 7.
  Available forms 1. SublingualTablets. 2. Topical Ointment and Transdermal Patches. 3. Translingual Spray. 4. Transmucosal Tablets. 5. Intravenous (IV). SIDE EFFECTS • Headache • flushing, • hypotension • dizziness
• 8.
  Therapeutic uses ofantianginal drugs Nitrates:- • Angina pectoris • MI • Congestive cardiac failure • Biliary colic • Cyanide poisoning • Oesophageal spasm CONTRAINDICATION •Hypersensitivity •Severe anaemia •Increased ICP •Cerebral haemorrhage
• 9.
  Isosorbide 1.Isosorbide mononitrate 2.Isosorbidedinitrate •Is a nitrate like nitroglycerin, and is used for treating and preventing angina. •It is NOT used to treat HTN. •Is given Sublingual or Per Oral . •SL Isosorbide has a slower onset and a longer duration of action compared to SL nitroglycerin . •Because SL isosorbide does NOT relieve chest pain as rapidly as introglycerin, Isosorbide is limited to treating acute angina in patients intolerant or unresponsive to SL nitroglycerin . 1.Isosorbide mononitrate:- 20 to 40 mg orally 2.Isosorbide dinitrate:- 5 -1o mg sublingually or orally
• 10.
  Ca++ channel blockers vasodilation Blockthe entry of ca++ ions into the smooth & cardiac muscles Decreased intracellular ca++ & causes smooth muscles relaxation
• 12.
  BETA BLOCKERS DECREASE CORONARYSUPPLY DECREASE THE HEART RATE BY BLOCKING BETA RECEPTOR DECREASE THE WORK OF HEART DECREASE O2 CONSUMPTION INCREASE REDISTRIBUTION OF BLOOD
• 13.
  ADVERSE EFFECT Hypotension Depression Bradycardia Heart blockCHF CONTRAINDICATION Heart block Pulmonary edema Cardiogenic shock
• 14.
  KCHANNEL OPNER
• 15.
  DRUG USED NICORANDIL 5-10MG TAB 2MG/VIAL ADVRSE EFFECT • FLUSHING • PALPITATION • WEAKNESS • DIZZINESS • NAUSEA • VOMITING