Essential notable points on Anti Anginal drugs

1. 1
Anti Anginal drugs
Dr. Remya Krishnan
Dept . Dravyagunavijnan
RGAMC , Mahe

2. 2
ANGINA PECTORIS ?
– Inadequate coronary blood flow-
Inadequate oxygen supply to the heart
– Sudden severe pressing substernal pain
radiating to left arm .
– Imbalance between oxygen requirement and
supply to the heart via coronary vessels .
– Atheromatous obstruction of large coronary
vessels .

3. 3
Solution
Decrease oxygen demand by decreasing
cardiac work.
Increasing coronary blood flow (difficult ) .
http://www.drugfree.org/Portal/Drug_Guide/Prescription%20Sedatives%20Tranquilizers (2)

4. 4
Types of Angina
Transient spasm of localised portions of
blood vessels associated with atheromas .
Causes significant ischaemia and pain .
Spasm can be reversed by nitrates or
calcium channel blockers .

5. 5
Anti anginal Drugs
Organic nitrates -Nitroglycerine
Beta blockers- Propanolol
Calcium channel blockers- Diltiazem,
Verapamil
http://www.drugfree.org/Portal/DrugIssue/Features/Prescription_Medicine_Misuse Accessed May 2, 2006.

6. 6
Organic nitrates
Rapidly reduce myocardial oxygen
demand and rapidly relieve symptoms (Eg
– Nitroglycerine).
They are effective in stable as well as
unstable Angina .
In cases of attacks triggered by exercise
or stress, sublingual or spray of GTN
(Nitroglyscerine ) is the choice .

7. 7
Mechanism of action of Nitrates
Administration of nitrates  Conversion to
nitrites Conversion to Nitric oxide 
Activation of Cyclic GMP
Dephosphorylation of Myosin light chain
 Vascular smooth muscle relaxation

8. 8
Nitroglycerine effects 0n CVS
Dilatation of large veins - Pooling of
blood in the veins  Decreases preload (
Venous return to the heart ) and cardiac
work .
Dilatation of coronary vasculature
Increased blood supply to the heart
muscle and decreased myocardial oxygen
consumption due to decreased cardiac
work .
http://images.google.com/imgres?imgurl=http://www.long-island-hypnotherapy.com/images/anxiety Accessed May 2, 2006.

9. 9
Adverse effects
Flushing of face
Throbbing head ache owing to pressing of
sensory nerve due to vasodilatation.
Postural hypotension due to decreased
central venous pressure .
Syncopal attack
Methaemoglobinaemia
Nitrate tolerance

10. 10
Nitrate tolerance
Due to long term administration, the nitrate
effect is gradually lowered and finally
complete or partial loss of effects .
Providing nitrate free interval and increase
the sensitivity of drug is the only solution .