This document discusses anti-ischemic drugs used to treat angina. It defines ischemia as insufficient blood supply and oxygen delivery to tissues. The main causes of ischemia are discussed as atherosclerosis and blood clots blocking arteries. Different types of angina - stable, unstable, and variant - are also defined. The document then summarizes the mechanisms and uses of several classes of anti-ischemic drugs - nitrates, beta-blockers, calcium channel blockers, and antiplatelet drugs. Specific drugs within each class are mentioned along with their mechanisms of action, indications, contraindications and importance in treating different forms of angina and acute coronary syndromes.
This presentation provides a knowledge about Ischemic heart Disease, Ischemia, Mechanism of Action, signs and symptoms, Causes of Ischemia, Ischemia in different body parts, Angina, Myocardial Infarction, Artherosclerosis, Drugs used to treat ischemia and recent discovery related to Cardiac ischemia. An assignment for the subject, Advanced Pharmacology-I, 1st year M.Pharm, 1st semester.
Non adrenergic non cholinergic transmission(nanc)Merlin Binu
Neurotransmitters other than Acetyl choline and NorAdrenaline of parasympathetic and sympathetic nervous system play important role in synaptic junction transmission. That neurotransmitters are called NANC.
Classification of receptors family by vivek sharmaAnimatedWorld
Definition- Receptor are the biologic molecule to which drug bind and produces a measurable response.
So, enzyme and structural proteins can be considerd to be pharmacologic receptors.
Majorly receptor are of 4 types and the molecule or a drug interact to receptor to give response often called as ligand.
The type of receptor a ligand will bind is depend on the nature of ligand.
Hydrophilliic ligand binds to the receptor found on the cell surface.
Hydrophobic ligand can enter the cell membrane to intract the receptor present on inside the cells.
Classification of Receptors
A. Cell surface receptor
Ligand-gated Ion Channel
G Protein Coupled Receptor
Enzyme linked Receptor
B. Intracellular Receptor
Nuclear Receptor
This presentation provides a knowledge about Ischemic heart Disease, Ischemia, Mechanism of Action, signs and symptoms, Causes of Ischemia, Ischemia in different body parts, Angina, Myocardial Infarction, Artherosclerosis, Drugs used to treat ischemia and recent discovery related to Cardiac ischemia. An assignment for the subject, Advanced Pharmacology-I, 1st year M.Pharm, 1st semester.
Non adrenergic non cholinergic transmission(nanc)Merlin Binu
Neurotransmitters other than Acetyl choline and NorAdrenaline of parasympathetic and sympathetic nervous system play important role in synaptic junction transmission. That neurotransmitters are called NANC.
Classification of receptors family by vivek sharmaAnimatedWorld
Definition- Receptor are the biologic molecule to which drug bind and produces a measurable response.
So, enzyme and structural proteins can be considerd to be pharmacologic receptors.
Majorly receptor are of 4 types and the molecule or a drug interact to receptor to give response often called as ligand.
The type of receptor a ligand will bind is depend on the nature of ligand.
Hydrophilliic ligand binds to the receptor found on the cell surface.
Hydrophobic ligand can enter the cell membrane to intract the receptor present on inside the cells.
Classification of Receptors
A. Cell surface receptor
Ligand-gated Ion Channel
G Protein Coupled Receptor
Enzyme linked Receptor
B. Intracellular Receptor
Nuclear Receptor
Immunoassays have been widely used in many important areas of pharmaceutical analysis such as diagnosis of diseases, therapeutic drug monitoring, clinical pharmacokinetic and bioequivalence studies in drug discovery and pharmaceutical industries.
Introduction to Screening Models of Anti-Atherosclerosis
Atherosclerosis, Screening models, In vitro models, In vivo models
Presented by
SHAIK FIRDOUS BANU
Department of Pharmacology
5-Hydroxytryptamine & it’s Antagonist is a Topic in Pharmacology which will defiantly Help You in pharmacy field All information is related to pharmacology drug acting and it's effect on body. it is collage project given by our department i would like to share with you.
Seretonin (5HT) and Its Antagonists PharmacologyPranatiChavan
Serotonin is a chemical that has a wide variety of functions in the human body. It is sometimes called the happy chemical, because it contributes to wellbeing and happiness.
The scientific name for serotonin is 5-hydroxytryptamine, or 5-HT. It is mainly found in the brain, bowels, and blood platelets.
Serotonin is used to transmit messages between nerve cells, it is thought to be active in constricting smooth muscles, and it contributes to wellbeing and happiness, among other things. As the precursor for melatonin, it helps regulate the body’s sleep-wake cycles and the internal clock.
It is thought to play a role in appetite, the emotions, and motor, cognitive, and autonomic functions. However, it is not known exactly if serotonin affects these directly, or if it has an overall role in co-ordinating the nervous system.
Screening Methods for behavioural and muscle Coordinationpradnya Jagtap
Screening Methods for behavioural and muscle Coordination
A. Motor activity and behaviour
1. Method of intermittent observation
2.Open field test
3.Hole board test
4.Combined open field test
B.Test for muscle coordination
1.Inclined plane method
2.Chimny test
3.Grip strength
4.Rotarod method
Immunoassays have been widely used in many important areas of pharmaceutical analysis such as diagnosis of diseases, therapeutic drug monitoring, clinical pharmacokinetic and bioequivalence studies in drug discovery and pharmaceutical industries.
Introduction to Screening Models of Anti-Atherosclerosis
Atherosclerosis, Screening models, In vitro models, In vivo models
Presented by
SHAIK FIRDOUS BANU
Department of Pharmacology
5-Hydroxytryptamine & it’s Antagonist is a Topic in Pharmacology which will defiantly Help You in pharmacy field All information is related to pharmacology drug acting and it's effect on body. it is collage project given by our department i would like to share with you.
Seretonin (5HT) and Its Antagonists PharmacologyPranatiChavan
Serotonin is a chemical that has a wide variety of functions in the human body. It is sometimes called the happy chemical, because it contributes to wellbeing and happiness.
The scientific name for serotonin is 5-hydroxytryptamine, or 5-HT. It is mainly found in the brain, bowels, and blood platelets.
Serotonin is used to transmit messages between nerve cells, it is thought to be active in constricting smooth muscles, and it contributes to wellbeing and happiness, among other things. As the precursor for melatonin, it helps regulate the body’s sleep-wake cycles and the internal clock.
It is thought to play a role in appetite, the emotions, and motor, cognitive, and autonomic functions. However, it is not known exactly if serotonin affects these directly, or if it has an overall role in co-ordinating the nervous system.
Screening Methods for behavioural and muscle Coordinationpradnya Jagtap
Screening Methods for behavioural and muscle Coordination
A. Motor activity and behaviour
1. Method of intermittent observation
2.Open field test
3.Hole board test
4.Combined open field test
B.Test for muscle coordination
1.Inclined plane method
2.Chimny test
3.Grip strength
4.Rotarod method
All new antibacterial agents which have been approved after the year 2000 have been described along with their mechanism of action, development of resistance, spectrum of activity and the stage of developmental in case of yet to be approved drugs.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
2. • Ischemia is a restriction in
blood supply to tissues,
causing a shortage of oxygen
that is needed for cellular
metabolism.
• Ischemia is generally caused
by problems with blood
vessels, with resultant
damage to or dysfunction of
tissue.
• Ischemia comprises not only
insufficiency of oxygen, but
also reduced availability of
nutrients and inadequate
removal of metabolic wastes
2
3. • One of the main causes of ischemia is atherosclerosis. That’s where
plaque collects in the arteries.
• Plaque is a hard, sticky substance that’s made mostly of fat. It builds
up slowly, but over time, it .
• This slows the blood flow because , blood has less space to move
through.
• Ischemia can be also due to blood clot. Plaque itself is a problem. But
sometimes, it can This causes a sudden
and serious stoppage to your blood flow..
3
4. What is atherosclerosis?
• Atherosclerosis is a narrowing of the arteries caused by a buildup of
plaque. It’s also called arteriosclerosis or hardening of the arteries.
Arteries are the blood vessels that carry oxygen and nutrients from
your heart to the rest of your body.
• As you get older in your arteries and
form plaque. The buildup of plaque makes it difficult for blood to flow
through your arteries.
• This buildup may occur in any artery in your body and can result in a
shortage of blood and oxygen in various tissues of your body. Pieces
of plaque can also break off, causing a blood clot. Atherosclerosis can
lead to heart attack, stroke, or heart failure if left untreated.
4
5. Pathophysiology of atherosclerosis
is considered one of the main triggers of
atherosclerosis. The increase in plasma cholesterol levels results in
that allow the
• Circulating to the endothelial cells that express
adhesion molecules , Once in the sub endothelial space, the monocytes
acquire macrophage characteristics
in the sub endothelial space are oxidised and become strong
These processes only enhance
The end result is a cascade of vascular
modifications .
• Clinical sequelae of atherosclerosis are vessel narrowing with symptoms
due to plaque instability.
5
7. ANGINA PECTORIS
• Angina pectoris , is
caused by transient episodes of myocardial ischemia that are due to
an
• Angina pectoris has three patterns:
1) effort-induced, classic, or typical angina;
2) ; and
3) , variant, vasospastic, or rest angina.
7
8. STABLE ANGINA
• Classic angina is the form of angina and, therefore, is
also called typical angina pectoris.
• It is usually characterized by a
• Classic angina is caused by the reduction of coronary perfusion due to
a .
• When the pattern of the chest pains and the amount of effort needed
to trigger the chest pains do not vary over time, the angina is named
“stable angina.”
• Typical angina pectoris is promptly
8
9. Unstable angina
• Unstable angina is classified In
unstable angina, chest pain occurs
• The symptoms are not relieved by rest or nitroglycerin. Unstable
angina is a and requires hospital
admission and more aggressive therapy to prevent progression to MI
and death.
9
10. Prinzmetal, variant, vasospastic, or rest angina
• Prinzmetal angina is an uncommon pattern of episodic angina that
occurs at rest and is Prinzmetal’s
angina almost always occurs when a person is at rest, usually
between These attacks can be very
painful.
• Symptoms are caused by decreased blood flow to the heart muscle
from the spasm of the coronary artery.
• Although individuals with this form of angina may have significant
coronary atherosclerosis, the
• Prinzmetal angina generally responds promptly to coronary
vasodilators, .
10
13. 1. Progressive narrowing of
2. Sudden enlargement of ASO plaque.
3. Sudden
by an intracoronary thrombus following rupture or erosion of an
ASO plaque.
4. usually in association with ASO disease e.g.
5. Other causes: coronary embolism, abnormal coronary rheology slow
flow, compression of epicardial coronary artery by myocardial bridge,
coronary ectasia.
13
14. 1. Heart rate.
2. Arterial pressure.
3. Myocardial inotropic state (contractility).
4. An increase in LV muscle mass (LVH).
14
16. • The main indication of this group is the .
• Myocardial ischemia is the result of imbalance between myocardial
oxygen supply and demand.
• Anti ischemic drugs produce their beneficial effect by either
16
17. • Mechanism of Action
• Clinical Indications
• Contraindications
• Uses in Acute Coronary Syndromes
• Nitrate Tolerance
17
18. • Three organic nitrates are currently used:
• MECHANISM OF ACTION:
A. Increase coronary blood supply.
B. Decrease myocardial oxygen consumption.
C. Antiplatelet action
18
19. Molecular Mechanism of Action
• Nitrates act through endothelial-independent pathway to relax all
types of vascular smooth muscle cells to varying degrees.
• Nitrates are converted to , which then
Guanylate cyclase, in turn, produces cyclic guanosine
monophosphate which leads to increased levels of
intracellular cGMP
• In platelets, increases in cGMP exert an
19
21. NITRATE PREPARATIONS
• Nitroglycerin (NTG)
• Available in many formulations, parenteral, sublingual, buccal, ointment and
patch.
• It has a ; Veins take up NTG more avidly
than arteries.
• Dosages
• : 0.3-0.6 mg, onset of action is 2-5 minutes and its duration is 20-
30 minute. The usual tablet dose is 0.3 mg to 0.4 mg repeated every five minutes
for a total of three doses.
• NTG tablets are both They should be stored in atightly
capped dark bottle in the refrigerator. Prescription should be renewed every
three to six months.
• : 0.4-0.8 mg/h, the patch should be applied for only 12-14 hours each
day.
21
23. Isosorbide Dinitrate (ISDN)
• The most widely
• Available as short-acting and sustained-release formulation.
• Onset of action is within 15 to 30 minutes and the duration of action is three to six
hours. There is
• Dosage:- 10 to 40 mg three times daily. There is no added benefit with 60 and 120 mg
doses.
• Tolerance has limited the usefulness of ISDN as a chronic antianginal agent.
Development of tolerance occurs despite higher plasma concentrations of ISDN during
maintenance therapy.
• To prevent the development of tolerance, it is recommended to give ISDN at 8 AM, 1 PM
and 6 PM. This regimen can offer antianginal protection for at least six hours.
• Begin with a dose of 10 mg three times daily and advance to 40 mg three times daily as
needed.
23
24. Isosorbide Mononitrate (ISMIN)
• Onset of action is within 30 minutes, and the duration of action is six
to eight hours. It is completely bioavailable.
• The usual starting dose is 20 mg twice daily to be increased to 40 mg
twice daily if necessary. Seven hours interval between doses followed
by 17 hours nitrate-free interval.
• Extended (sustained) release preparation is given once daily and lasts
12 hours.
24
25. CONTRAINDICATIONS
• Patients who have taken
• Patients even those without a
resting gradient across left ventricular outflow tract.
• Patients with suspected right ventricular infarction because of risk of
hypotension.
• Use cautiously in patients with severe aortic stenosis or with volume
depletion.
25
26. USE OF NITRATES IN ACUTE CORONARY SYNDROMES
• IV NTG is preferable because of its short half life and feasibility of rapid
dose titration. Tolerance may develop after 24 hours with recurrence of
chest pain. Such patients respond to dose increases.
• Once the patient has been stabilized, IV NTG can be tapered gradually, and
intermittent therapy with long-acting oral nitrate can be started about 1-2
hours, before discontinuation of the nitrate infusion.
• Recent guidelines recommend the use of nitrates for the first 24 to 48
hours in patients with AMI who have an indication for nitrate therapy such
as: recurrent ischemia, heart failure or hypertension. The infusion of IV
NTG should be initiated at 5 to 10 mcg/min and gradually increased
26
27. • . The goal is a 10% reduction in systolic blood pressure for
normotensive subjects and approximately a 30% reduction in systolic
blood pressure in hypertensive patients, avoiding hypotension.
• IV NTG is discontinued within 24 to 48 hours. Long acting oral
nitrates may be indicated in patients with significant residual ischemia
or heart failure.
27
28. NITRATE TOLERANCE
• Attenuation and sometimes abolition of hemodynamic and antianginal
effects of nitrates.
1. Increased Superoxide
anions inactivate nitric oxide.
2. necessary for biotransformation of nitrate
to nitric oxide (NO).
3
.
• Intermittent therapy with an adequate nitrate-free interval. It is thought
that a nitrate-free interval permits the generation of reduced sulfhydryl
groups
28
29. 𝛃-ADRENERGIC BLOCKERS
• The β-adrenergic blockers
, resulting in decreased heart
rate, contractility, cardiac output, and blood pressure.
• These
As such, they can reduce both the frequency and severity of
angina attacks.
• Agents with intrinsic sympathomimetic activity (ISA) such as pindolol
should be avoided in patients with angina and those who have had a
MI.
.
• Thus, other β-blockers, such as are
preferred.
29
34. CONTRAINDICATIONS
• In and may actually
worsen symptoms.
• β-Blockers should be .
• Nonselective β-blockers should be avoided in patients with asthma.
• [Note: It is important not to discontinue β-blocker therapy abruptly.
The dose should be gradually tapered off over 2 to 3 weeks to avoid
rebound angina, MI, and hypertension.]
34
36. CALCIUM CHANNEL BLOCKERS
• Voltage-sensitive Ca2+ channels (L-type or slow channels)
albeit by different mechanisms.
• Ca2+ channel antagonists, also called
• These drugs also produce
36
37. • Calcium influx is increased in ischemia because of the membrane
depolarization that hypoxia produces. In turn, this promotes the
activity of several ATP-consuming enzymes,
• All calcium channel blockers are, therefore,
that cause a .
• In the treatment of effort-induced angina, calcium channel blockers
reduce myocardial oxygen consumption by decreasing vascular
resistance, thereby decreasing afterload.
37
38. A. Dihydropyridine calcium channel blockers
• Amlodipine an functions mainly as an arteriolar
vasodilator. This drug has minimal effect on cardiac conduction. The
vasodilatory effect of amlodipine is
.
• Nifedipine is another agent in this class; it is usually administered as
an extended-release oral formulation.
• [Note: Short-acting dihydropyridines should be avoided in CAD
because of evidence of increased mortality after an MI and an
increase in acute MI in hypertensive patients.]
38
39. slows atrioventricular (AV) conduction directly
Verapamil has greater negative inotropic effects than
amlodipine, but it is a weaker vasodilator
• Diltiazem also slows AV conduction, decreases the rate of firing of the
sinus node pacemaker, and is also a coronary artery vasodilator.
Diltiazem can relieve coronary artery spasm and is particularly useful
in patients with variant angina.
39
43. DRUGS
aspirin small dose (75-325 mg)
epoprostenol but very short half life.
Clopidogrel,ticlopidine,prasugrel,ticagrelor.
abciximab-tirofiban-eptifibatide.
43