what is angina? Antianginal agent

1. SUJIT KARPE
PRINCIPAL,
SOJAR COLLEGE OF PHARMACY,
KHANDVI

7. Ischemia (angina pectoris ):
imbalance between oxygen demand and supply

8. CAUSES OF ANGINA
VASOSPASM ATHEROSCLEROSIS

9. SYMPTOMS OF ANGINA

10. Classical
angina
Prinzmetal
angina

11. Reducing oxygen demands
Reducing heart rate and contractility
Dilating systemic arteries and veins (  wall tension by lowering
heart loads)
Increasing oxygen supply
Dilating coronary arteries (  coronary blood flow)
Promoting regional distribution (  in ischemic regions)
Others:
Anti- platelet coagulation and thrombus formation
EFFECTS OF ANTIANGINAL DRUGS

12. 1. Organic nitrates
 Nitroglycerine
 amyl nitrite
 Isosorbide dinitrate
2. Beta adrenergic blocking agent
 Propranolol
3. Calcium channel blockers
 Nifidepine
 Verapamil
CLASSIFICATION OF ANTIANGINAL
DRUGS

13. ANTI ANGINAL AGENT

14. ANTI ANGINAL AGENT – ORGANIC
NITRATES
MOA

16. ANTI ANGINAL AGENT – ORGANIC
NITRATES
 Directly relax smooth muscles.
 Dilates all types of blood vessels.
 Lowers resting blood pressure, lower myocardial oxygen requirement, relieves
angina attack.
 Shortens duration of cardiac systole and also reduce cardiac size.
 Thus nitrates reduces cardiac work.
 Decreases venous return, reduces end diastolic pressure, volume and reduces
ventricular size and wall tension.
 This improves ventricular efficiency and reduces oxygen demand.

17. ANTI ANGINAL AGENT – ORGANIC
NITRATES

18. ANTI ANGINAL AGENT – ORGANIC
NITRATES
THERAPEUTIC USES
 To treat angina pectoris
 For bronchial asthma
 In trigeminal neuralgia
 In Raynaud’s disease

19. ANTI ANGINAL AGENT – ORGANIC
NITRATES
PREPARATIONS
 Sodium nitrite – 0.3-0.5 g in 15 ml
water is injected I/V
 Nitroglycerine – 0.15 to 0.6 mg
Sublingually.
 Iso-sorbide – 5 -10 mg Sublingually.

21. ANTI ANGINAL AGENT – BETA
BLOCKERS PROPRANOLOL

22. ANTI ANGINAL AGENT – BETA
BLOCKERS PROPRANOLOL
 Produces protective action
 Blocks activity of heart mediated through beta blocker
 Reduces rate, contractility and thus oxygen demand
 Propranolol is combined with nitrates to obtain synergistic effect.
 Hypoxia and precipitation of CCF are common side effects
 Preparation – propranolol: 10 – 40 mg t. i. d.

23. ANTI ANGINAL AGENT – CALCIUM
CHANNEL BLOCKERS (CCBs)
MOA

24. ANTI ANGINAL AGENT – CALCIUM
CHANNEL BLOCKERS (CCBs)
 Blocks the entry of calcium in myocardial and vascular smooth
muscles and thus decrease availability of intracellular calcium.
 Blocks entry of extracellular calcium ions.
 Depresses contractility of myocardium, reduces cardiac work and
oxygen consumption.
 Orally, it is effectively and completely absorbed.
 Constipation, leg cramps and heart block are major side effects.

25. Clinical uses
stable and variant type:
nifedipine, verapamil, diltiazem
unstable type:
verapamil, diltiazem
Actions of DHP (like nifedipine) are similar to those of nitroglycerin
Actions of verapamil and diltiazem are similar to those of  blockers
ANTI ANGINAL AGENT – CALCIUM
CHANNEL BLOCKERS (CCBs)