Cardiovascular Drugs (Angina)

Angina pectoris

sudden and severe chest pain that radiates. Occurs due to an obstruction of blood flow (and therefore oxygen distribution) to the heart secondary to coronary artery or ischemic heart disease. Can also occur due to spasms of vascular smooth muscle.

Stable angina

angina induced by effort such as exercise or stress. Characterized by short lasting burning and a tightness of the chest. More atypical presentation occur in women, diabetic patients, and the elderly. Ie) fatigue and nausea.

Unstable angina

angina characterized by chest pain that occurs with increased frequency, duration, and intensity even with limitations on risk factors. Will not improve with rest or nitroglycerin and requires admission to the hospital.

Variant angina

angina where an uncommon episodic pattern occurs while at rest. Can be caused by spasm of the coronary arteries via significant coronary atherosclerosis. Attacks do not correlate with physical activity, heart rate, or blood pressure. Will response to vasodilators such as nitroglycerin or calcium channel blockers

Acute coronary syndrome

an emergency case of angina where there is a rupture of an atherosclerotic plaque and thrombosis of a coronary artery occurs. Necrosis of the heart tissue may occur which can be detected via serum levels of biomarkers such as troponins and creatine kinase.

smoking cessation

physical activity

weight management

manage risk factors

four Lifestyle Modifications to Reduce Angina

blood pressure

venous return

heart rate

contractility

Drugs used in the treatment of angina affect these four factors in order to balance cardiac oxygen supply..

Beta blockers

drugs used in the treatment of angina that decrease the oxygen demand of the myocardium by blocking beta receptors. This decreases heart rate, contractility, cardiac output, and blood pressure. Recommended as initial antianginal therapy, unless contraindicated.

metroprolol

atenolol

two beta blockers used in the treatment of angina

rebound angina

what do beta blockers caused if not tapered during the treatment of angina?

drugs with sympathetic activity

bradycardia

asthma

three contraindications of beta blockers

Calcium channel blockers

drugs used in the treatment of angina that preventing the entry of calcium into cardiac and smooth muscle cells. Decrease myocardial oxygen consumption by decrease vascular resistance (afterload).

verapamil

diltiazem

amiodipine

three calcium channel blockers used in angina

Verapamil

calcium channel blocker used in the treatment of angina that has a greater negative inotropic effect, but is a weaker vasodilator. Slows AV node conduction directly to decrease heart rate.

Diltiazem

calcium channel blocker used in the treatment of angina that can relieve coronary artery spasm and is particularly useful in variant angina.

heart failure

one contraindication of calcium channel blockers

Organic nitrates

drugs used in the treatment of angina that cause a reduction in myocardial oxygen demand via their conversion to nitric oxide. Nitric oxide increases levels of cGMP which causes dephosphorylation of the myosin light chain resulting in vascular smooth muscle relaxation.

nitroglycerin

isosorbide mononitrate

isosorbide dinitrate

three organic nitrates used in angina

sublingual, spray, transdermal

three modes of admnistration for nitroglycerin

oral

mode of administration for isosorbide mononitrate

phosphodiesterase type 5 inhibitors

should not be taken with organic nitrates because they will potentiate their effects and lead to dangerous hypotension

Sodium channel blockers

drugs used in the treatment of angina that inhibit the late phase sodium current improving oxygen supply via the reduction of intracellular sodium and calcium overload.

ranolazine

sodium channel blocker used in angina. used in patients who have failed other anti-anginal therapies