1.Introduction 2.Type of angina 3.Risk factors 4.Pharmacology and classification of antianginal drugs 1.Nitrates Nitroglycerine, isosorbide dinitrate, isosorbide mononitrate, 2. Calcium channel blockers Verapamil, diltiazem, amlodipine, nifedipine, Nicardipin, 3.β-blockers Propranolol, atenolol, metoprolol, 4. Potassium channel openers Nicorandil, minoxidil, diazoxide, 5.Other antianginal Dipyridamole, aspirin, trimetazidine

1. Anti-anginal drugs
Prepared By – UndhadTushar C.
Masters Of Pharmacy Sem – 1 (Pharmacology)

2. CONTENTS
• 1.Introduction
• 2.Type of angina
• 3.Risk factors
• 4.Pharmacology of antianginal drugs
• 5.Reference
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3. 1.Introduction
Angina pectoris is the chief
symptom of ischemic heart disease
(IHD) characterized by sudden,
severe, pain which may radiate to
the left shoulder and surface of the
left arm.
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4. 1.Introduction
• Myocardial oxygen
consumption depends
on preload afterload
and heart rate.
• When the oxygen
supply to the
myocardium is
insufficient for its
needs, myocardial
ischemia develops.
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5. 2.Type of angina
• 1.stable angina
• 2.unstable angina
• 3.variant angina
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6. 2.Type of angina
1. Classical angina
(stable angina):
• Pain is induced by
exercise or emotion,
both of which increase
myocardial oxygen
demand.
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7. 2.Type of angina
• In such patients there is
narrowing of the coronary
arteries due to atherosclerosis
and therefore the coronaries
cannot dilate to increase the
blood supply during exercise.
• Hence there is an imbalance
between oxygen supply and
demand.
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8. 2.Type of angina
2.Unstable angina:
• Unstable angina is classified between stable
angina and Myocardial infraction.
• What cause unstable angina- this atheroma
plague rapture and blood clot may form and
decrease blood flow in the artery.
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9. 2.Type of angina
• 3.Variant angina
• angina that occurs at rest
and is due to coronary
artery spasm.
• Symptoms are caused by
decreased blood flow to
the heart muscle from the
spasm of the coronary
artery.
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10. 3.Risk factors
• Hyperlipidaemia
• Hypertension
• Diabetes
• Smoking
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11. 4.Classification of antianginals drugs
Class of drugs Name of drugs
1. Nitrates Nitroglycerine, isosorbide
dinitrate, isosorbide mononitrate,
2. Calcium channel
blockers
Verapamil, diltiazem, amlodipine,
nifedipine, Nicardipin,
3.β-blockers Propranolol, atenolol, metoprolol,
4. Potassium channel
openers
Nicorandil, minoxidil, diazoxide,
5.Other antianginal Dipyridamole, aspirin,
trimetazidine
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12. 1. Nitrates
• Ex - Nitroglycerine, Isosorbide Dinitrate, Isosorbide
Mononitrate
• MOA:- Nitrates are vasodilators.
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13. 1. Nitrates
• They are converted to
nitric oxide.
• Activates vascular guanylyl
cyclase which increases
the synthesis of cGMP.
• This cGMP catalases the
phosphorylation of protein
kinases causing relaxation
of the smooth muscles.
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14. 1. Nitrates
• Pharmacokinetics :-
• Organic nitrates are lipid-soluble: well absorbed
from buccal mucosa. Action occur 5-7 min.
• Half life 2-5 hr.
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15. 1. Nitrates
• ADR:-
• Palpitation
• Fatigue, dizziness
• Postural hypotension
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16. 1. Nitrates
• USE:
• Angina pectoris
• Cardiac failure
• Myocardial infarction (Ml)
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17. 2.Calcium channel blockers
• Ex - Verapamil, Diltiazem, Amlodipine,
Nifedipine, Nicardipin.
• MOA:
• The intracellular concentration of calcium
plays an important role in maintaining the
tone of smooth muscle and in the
contraction of the myocardium.
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18. 2.Calcium channel blockers
• Calcium enters muscle cells through special
voltage sensitive calcium channels.
• This triggers release of calcium from the
sarcoplasmic reticulum and mitochondria, which
further increases the cytosolic level of calcium.
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19. 2.Calcium channel blockers
• Calcium channel blocker block L-type calcium
channels in the heart and in smooth muscle of
the coronary and peripheral arteriolar.
• This causes vascular smooth muscle to relax,
dilating mainly arterioles
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20. 2.Calcium channel blockers
• Pharmacokinetic action :
• Most of these agents have short half-lives (3 to 8
hours)
• Metabolized in liver
• Excreted in urine
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21. 2.Calcium channel blockers
• ADR:
• Dizziness, headache, and a feeling of fatigue
caused by a decrease in blood pressure
• Peripheral edema is another commonly reported
side effect of this class.
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22. 2.Calcium channel blockers
• Therapeutic uses:
• Hypertension
• Treatment of angina
• Arrhythmias
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23. 3.β-blockers
• Ex- Propranolol, Atenolol, Metoprolol.
• MOA:
• Blockade of cardiac β1 receptors results in
decreased myocardial contractility and cardiac
output.
• They reduce the BP due to a fall in the cardiac
output.
• They also lower plasma renin activity and have
an additional central antihypertensive action.
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24. 3.β-blockers
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Mechanism of action:

25. 3.β-blockers
• Pharmacokinetic action :
• β-blockers are orally active
• Metabolised in the liver
• t½ is 3-7 hrs.
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26. 3.β-blockers
• ADR:
• Bradycardia
• Fatigue
• Insomnia
• Sexual dysfunction
• Hypotension
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27. 3.β-blockers
• Therapeutic uses:
• Previous myocardial infarction,
• Angina pectoris
• Chronic heart failure
• Hypertension
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28. 4. Potassium channel openers
• MOA:
• Opening these channels
hyperpolarizes the smooth
muscle, which closes voltage-
gated calcium channels and
decreases intracellular calcium.
• This leads to relaxation and
vasodilation.
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Ex - Nicorandil, Minoxidil, Minoxidil, Diazoxide

29. 4. Potassium channel openers
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30. 4. Potassium channel openers
• ADR:
• Headaches, flushing
• Reflex tachycardia
• Fluid and salt retention
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31. 4. Potassium channel openers
• Therapeutic uses:
• Hypertension
• Smooth muscle relaxing activity
• Vasodilator to treat angina
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32. 5.References:
• Essentials Of Medical Pharmacology 8th Edition
2018 By KDTripathi
• Lippincott's pharmacology
• Padmaja Uday Kumar Professor and Head
Department of Pharmacology Fr. Muller Medical
College, Mangalore Karnataka India
• Goodman and Gilman’s The Pharmacological Basis of
Therapeutics, 11th -Edition 2006
• Rang & Dale’s Pharmacology, Eighth edition
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