14 -anti-anginal drugs

b. Ranolazine

1. First-line drug for chronic stable angina

   a. Trimetazidine

   b. Ranolazine

   c. Propranolol

   d. Nitroglycerin

a. amyl nitrate

2. An anti-anginal drug that is also useful in the tx of cyanide poisoning

   a. amyl nitrate

   b. isosorbide dinitrate

   c. isosorbide mononitrate

   d. sildenafil citrate

a. Increases the level of cGMP

3. MOA of nitroglycerin

   a. Increases the level of cGMP

   b. increases the level of cAMP

   c. increases the level of IP3

   D. Increases the level of DA release

a. beta blockers

4. Reflex Tachycardia management

   a. beta blockers

   b. hydralazine

   c. nitroprusside

   d. nitroglycerin

a. CCBs

5. DOC prinzmental angina

   a. CCBs

   b. beta-blockers

   c. ACEI’s

   d. hydralazine

ANGINA PECTORIS

Strangling of chest/chest pain

Ischemia

restricted blood supply → shortage of oxygen

Stable Typical Angina

What type of angina is this?

• MOST Common

• predictable

• emotional stress

• exercise

• Heavy meals

• Cold temperature

Unstable Typical Angina

What type of angina is this?

• Can predicted during medical emergency (pre-infarcation)

• rest angina

• more severe (emergency!!)

Variant/Prinzmetal Atypical Angina

What type of angina is this?

• rare

• happens during rest, or sleep

Rest or Nitroglycerin

Tx for Stable Typical Angina

• Anti-thrombotic drugs,

• lipid lowering drugs,

• Anti-platelets (ASA), F

• ibrinolytics

Tx for unstable Typical Angina

CCB’s/ Nitrates

Tx for Variant/Prinzmetal Atypical Angina

Beta-blockers)

Variant/Prinzmetal Atypical Angina is C/I to:

lack oxygen supply = high oxygen demand

Angina Pectoris Problem:

increase supply & Decrease demand

Goals of therapy for Angina Pectoris:

CCBs, Beta-Blockers

Drugs for decreasing HR & Contractility

Nitrates

• Drugs that decrease preload (venous pressure):

• preferably relax VENOUS smooth muscle (result: ↓pre-load = ↓oxygen demand)

CCBs

Drugs that decrease afterload (arterial pressure):

• Amyl Nitrite

• Nitroglycerin

• Isosorbide dinitrate & isosorbide mononitrate

Organic Nitrates and Nitrites’ drugs:

excessive vasodilation, Reflex Tachycardia

Nitrates’ A/E:

reflex tachycardia

NITRATES + VIAGRA = can cause what condition?

Amyl Nitrite

• only nitrite for angina pectoris

• Tx for Cyanide Toxicity

• S/E: euphoria, increase libido (“poppers”)

Dihydropiridines

• Relax arterial smooth muscles

• Decrease afterload

Non- dihydropiridines

• Decrease HR & contractility

• Decrease demand

decrease HR & CR = decrease demand

Beta blockers MOA:

Beta blockers

often used in

• Typical angina: prevent exerciseinduced tachycardia, reflex tachycardia

• Acute MI: decrease recurrence of MI and improve survival

• Ivabradine

• Ranolazine

• Trimetazidine

OTHER ANTIANGINAL AGENTS

Ivabradine

• MOA: inhibit If current in SA node (pacemaker current) → decrease HR

• Tx for chronic angina and HF

Ranolazine

• approved as a 1st agent for chronic stable angina

• block excessive prolongation of the late inward sodium current (INa-L) in myocardial cells

Trimetazidine

• blocks ketoacyl coA thiolase (Result: dec fatty acid oxidation)

• decrease FA metabolism evokes a compensatory increase in glucose metabolism and reduces oxygen consumption by about 20%

• Metabolism of glucose requires low oxygen than FA metabolism