Anti anginal drugs and What's anginal pectoris

1. Anti Anginal drugs
Dr. Haji Bahadar, PharmD, PhD
Assistant Professor
Khyber Medical University-IPMS

2. What is Angina Pectoris ?
 Angina pectoris means “chest pain” or
discomfort.
 Chest pain occurs when the heart muscles
do not receive sufficient blood, also
called ischemia.
REASONS:
 Coronary heart disease: in coronary heart's
disease the arteries become narrow or
blocked,
 Emotional stress
 Exposure to very cold temperature

4. When does it occur?
 During physical activity or strong
emotions. Severely narrowed arteries
may not allow enough blood to reach the
heart tissue
 When the demand for oxygen is more.
Physical exertion like walking up a hill or
climbing stairs the heart works harder
and needs more oxygen.

7. Different types of angina (self)



8. Diagnosis
 An electrocardiogram (ECG)
 Stress test ETT

10. Angina is chest pain caused by an imbalance between
oxygen supply (decreased coronary blood flow) and
oxygen demand (increased myocardial oxygen consumption), which
leads to a decrease in the oxygen supply/demand ratio and myocardial
hypoxia.

12. Treatment of angina
 Beta-blockers:
 Calcium channel blockers
 Nitrates: Nitroglycerin, Isosorbide
 Antiplatelet: aspirin, clopidogril
 Sodium channel blocker: Ranolazine
 Potassium-Channel Openers:
Nicorandil

nitroglycerin sublingual tablet

14. Mechanism of action of nitrates??

15. The role of nitric oxide in
vasodilatation
 Endothelium refers to cells that are present at
interior surface of blood vessels
 Nitric oxide (NO) is produced by vascular
endothelium regulating of blood flow
 NO is produced from the amino acid L-
arginine by the enzymatic action of nitric oxide
synthase (NOS) in the endothelial cells
 It diffuses into the vascular smooth muscle cells,
binds to and activates guanylyl cyclase. This
enzyme catalyzes the dephosphorylation of GTP
to cGMP. cGMP functions as a second
messenger for signaling smooth muscle
relaxation.

16. Cyclic GMP function
 Indirectly stimulate myosin light chain
phosphatase, the enzyme that
dephosphorylates myosin light chains, which
leads to smooth muscle relaxation.

18. Vascular Effects of NO
 Direct vasodilation
 Indirect vasodilation by inhibiting
vasoconstrictor influences (e.g.,
inhibits angiotensin II

19. Mechanism of action of nitrates
 Nitrates lead to the formation of the
NO which activate guanylyl cyclase,
increasing the cellular level of cyclic GMP
and subsequent vasodialation.

20. Potassium-Channel Openers
 Potassium-channel openers are drugs that
activate K+-channels in vascular smooth
muscle.
 Opening these channels hyperpolarizes
the smooth muscle, which closes voltage-
gated calcium channels and decreases
intracellular calcium.
 Less calcium available to combine with
contractile proteins leads to vasodilation

22. Surgical procedures
 Angioplasty is a procedure in which a
small catheter (a little tube) is inserted
into a narrowed or blocked artery.
 Coronary artery bypass surgery

24. Common side effects of nitrates
 Headache
 Lightheadedness
 Dizziness
 Flushing
 Low blood pressure
 Reflex tachycardia
Nitrates/nitrites are a very common headache and migraine

25. MIGRAINE TREATMENT
 Triptan medications include sumatriptan
(Imitrex), rizatriptan (Maxalt), almotriptan
(Axert), naratriptan (Amerge),
zolmitriptan (Zomig)