Lesson 5.3. Anti-Angina and Coronary Artery Disease Drugs

Angina

• Not a disease, but a symptom of inadequate oxygen delivery (ischemia) to the heart muscle.

• Characterized by chest pain or discomfort due to reduced blood flow to the myocardium

Stable angina

Types of Angina

• predictable, triggered by stress, lasts for a short time and can be relieved by rest

Unstable Angina

Types of Angina:

• unpredictable, not triggered by stress, lasts for a long time and is not relieved by rest

Prinzmetal / Variant angina

Types of Angina

• unpredictable, sometimes triggered by stress, worsens overtime and is not relieved by rest

Coronary Artery Disease

• characterized by narrowing or blockage due to atherosclerosis (plaque buildup)

• results in reduced oxygen supply to the myocardium → angina, myocardial ischemia, or infarction

nitro compounds and ranolazine

anti angina drugs

Nitroglycerin, Isosorbide Mononitrate, Isosorbide Dinitrate

Drugs under nitro compounds

increases nitric oxide

MOA of Nitro Compounds:

• _________________________ which results in vasodilation and relieve chest pain

Monday’s Disease

Nitro compounds causes _______________. Once tolerance is lost, re-exposure to nitro compounds causes fast HR, dizziness, and headache

Nitroglycerin Structure

Isosorbide Mononitrate Structure

Isosorbide Dinitrate (ISDN) Structure

late Na + current

MOA of Ranolazine:

• selectively inhibits ______________ leading to decreased intracellular Na + levels and Na + overload, modifying contractility leading to cardioprotective effects.

Angina (combined with CCBs, β-blockers, or nitrates)

Use of Ranolazine

Ranolazine Structure