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  • Antianginal Drugs Garrett J. Gross
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  • Myocardial Preconditioning
    • Single or multiple brief periods of ischemia result in a marked reduction in infarct size when the hearts are exposed to a more prolonged period of ischemia.
    • Has 2 phases:Acute and Delayed PC
    • Acute phase lasts 1-2 Hours
    • Delayed phase lasts 24-72 Hours
    • Nitrogycerin(GTN) produces delayed PC in animal and clinical studies.
    • This effect persists even in the presence of tolerance to its vasodilator effects
  • " Decrease in the effect of a drug when administered in a long-acting form" NITRATES TOLERANCE Develops with all nitrates Is dose-dependent Disappears in 24 h. after stopping the drug Tolerance can be avoided - Using the least effective dose - Creating discontinuous plasma levels
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  • NITRATES CONTRAINDICATIONS Previous hypersensitivity Hypotension ( < 80 mmHg) AMI with low ventricular filling pressure 1 st trimester of pregnancy WITH CAUTION:
    • Constrictive pericarditis
    • Intracranial hypertension
    • Hypertrophic cardiomyopathy
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  • ß-ADRENERGIC BLOCKERS CONTRAINDICATIONS Hypotension: BP < 100 mmHg Bradycardia: HR < 50 bpm Chronic bronchitis, ASTHMA Severe chronic renal insufficiency
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  • Reasons for Using Nitrates and Beta Blockers in Combination in Angina
    • Beta Blockers prevent reflex tachycardia and contractility produced by nitrate-induced hypotension.
    • Nitrates prevent any coronary vasospasm produced by Beta Blockers.
    • Nitrates prevent increases in left ventricular filling pressure or preload resulting from the negative inotropic effects produced by Beta Blockers.
    • Nitrates and Beta Blockers both reduce myocardial oxygen consumption by different mechanisms.
    • Nitrates and Beta Blockers both increase subendocardial blood flow by different mechanisms
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