1. Antianginal Drugs Claro M. Isidro M.D.

17. Potential Deleterious Effects Deleterious Effects Results Reflex tachycardia Increase myocardial oxygen requirement Reflex increase in contractility Decrease diastolic perfusion Decrease myocardial perfusion

18. ROUTES OF ADMINISTRATION 1. Sublingual route – rational and effective for the treatment of acute attacks of angina pectoris. Half-life depend only on the rate at which they are delivered to the liver. 2. Oral route – to provide convenient and prolonged prophylaxis against attacks of angina 3. Intravenous Route – useful in the treatment of coronary vasospasm and acute ischemic syndrome. 4. Topical route – used to provide gradual absorption of the drug for prolonged prophylactic purpose .

19. Drug Usual single dose Route of administration Duration of action Short acting Nitroglycerin 0.15-1.2 mg sublingual 10 - 30 min Isosorbide dinitrate 2.5-5 mg sublingual 10 – 60 min Amyl nitrite 0.18 – 3 ml inhalation 3 – 5 min Long acting Nitroglycerin sustained action 6.5 – 13 mg q 6-8 hrs oral 6 – 8 hrs Nitroglycerin 2% ointment 1 – 1.5 inches q hr topical 3 – 6 hrs Niroglycerin slow released 1 –2 mg per 4 hrs Buccal mucosa 3 – 6 hrs Nitroglycerin slow released 10 – 25 mg /24hrs (one patch/day} transdermal 8 –10 hrs Isosorbide dinitrate 2.5 – 10 mg per 2 hrs sublingual 1.5 – 2 hrs Isosorbide dinitrate 10 –60 mg per 4-6 hrs oral 4 – 6 hrs Isosorbide dinitrate chewable 5 – 10 mg per 2-4 hrs oral 2 – 3 hrs Isosorbide mononitrate 20 mg per 12 hrs oral 6 –10 hrs

34. Type of Angina Other Names Description Drug Therapy STABLE Classic Exertional Fixed Atherosclerotic Obstruction coronary artery Nitrates CCB B-blockers VARIANT Prinzmetal’s Vasospasmic Vasospasm at any time Nitrates CCB UNSTABLE Crescendo Combined effect Pre= MI Nitrates CCB