DRUGS FOR ANGINA - CCB AND BETA BLOCKER

Calcium Channel blocker

Decrease O2 demand by lowering aortic pressure

Inhibits calcium entry into arterial smooth muscle

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Decreased arteriolar tone and systemic vascular resistance

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Resulting in decrease arterial and intraventricular pressure

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Decreases myocardial contractile force

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reduces myocardial oxygen requirements

Effect:

*Relaxation of arteries / resistance vessels → decrease afterload / systolic wall tension → decrease O2 demand

Mechanisms of Clinical Effects of CCB and the effect

Nitroglycerin

Prinzmetal Angina

atherosclerotic angina

Use of CCB that is combined with _____ for the management of ____ & severe_____

Orally active agents

High first-pass effect, high plasma protein binding and extensive metabolism

Pharmacokinetics of CCB

Verapamil

the first clinically useful member of CCB

Verapamil and Diltiazem

This CCB for angina are also used by the IV route

Verapamil and Diltiazem

This CCB for angina are cardiac depressants (hypotension → bradycardia)

Nifedipine

the prototype of the dihydropyridine family of calcium channel blockers

more on vasodilation effect → hypotension → reflex tachycardia

Effect of nifedipine on angina

acute anginal attacks

Nifedipine has also been used to abort ____

Nifedipine

Devoid of a cardiodepressant effect, but may give rise to reflex tachycardia and an associated increase in O2 demand

Nifedipine

may be useful in chronic stable, or in variant angina

calcium antagonists

Nifedipine in coronary spasm, ____ can induce spasmolysis and improve blood flow

Beta blockers

Are extremely useful in the management of angina pectoris associated with effort.

Beta blocker

Prophylactic agent for chronic stable angina only, not for acute attack

Nitroglycerin

Combined with Nitroglycerin to prevent reflex tachycardia

Hemodynamic effect

decreased heart rate, blood pressure and contractility.

• which decrease myocardial oxygen requirements at rest and during exercise

What effect of Beta blocker?