These slides were used for discussion in B. Pharmacy 2nd year Pharmacotherapy theory class. Students are suggested to refer textbooks for further information.
These slides were used for discussion in B. Pharmacy 2nd year Pharmacotherapy theory class. Students are suggested to refer textbooks for further information.
Anti anginal drugs, uses, mechanism of action, adverse effectsKarun Kumar
A presentation outlining the causes of angina, mechanism of action of various anti-anginal drugs, their uses and side effects alongwith contraindications
Hypertension is defined as persistently elevated arterial blood pressure (BP).
JNC7 Guidelines: Seventh Report of the Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure
JNC7 is the national clinical guideline that was developed to aid clinicians in the management of hypertension.
Diuretics
Pharmacology
Katzung
Abnormalities in fluid volume and electrolyte composition are common and important clinical disorders. Drugs that block specific transport functions of the renal tubules are valuable clinical tools in the treatment of these disorders. Although various agents that increase urine volume (diuretics) have been described since antiquity, it was not until 1937 that carbonic anhydrase inhibitors were first described and not until 1957 that a much more useful and powerful diuretic agent (chlorothiazide) became available. Technically, a “diuretic” is an agent that increases urine volume, whereas a “natriuretic” causes an increase in renal sodium excretion and an “aquaretic” increases excretion of solute-free water. Because natriuretics almost always also increase water excretion, they are usually called diuretics. Osmotic diuretics and antidiuretic hormone antagonists (see Agents That Alter Water Excretion) are aquaretics that are not directly natriuretic.
Sympatholytics or Adrenergic AntagonistsAhmad Naeem
Sympatholytics or Adrenergic Antagonists (Introduction, Classification, Alpha Blockers, Beta Blockers Generations, Respirine)
These are drugs which antagonize the receptor action of adrenaline and related drugs.
Mechanism of Action
The adrenergic antagonists (also called adrenergic
blockers or sympatholytics) bind to adrenoceptors but
don’t trigger the usual receptor-mediated intracellular effects.
These drugs act by either reversibly or irreversibly
attaching to the adrenoceptors, thus preventing
activation by endogenous catecholamine's.
Numerous adrenergic antagonists have important
roles in clinical medicine, primarily to treat diseases associated with the cardiovascular system.
α-Adrenergic Blocking Agents
These drugs inhibit adrenergic responses mediated through the α adrenergic receptors without affecting those mediated through β receptors.
Mechanism of action
Drugs that block α adrenoceptors profoundly affect blood pressure. Blockade of these receptors reduces the sympathetic tone of the blood vessels, resulting in decreased peripheral vascular resistance. This induces a reflex tachycardia resulting from the lowered blood pressure.
Non-Selective α adrenergic antagonists
They cause vasodilation by blocking both alpha-1 and alpha-2 receptors. The blockage of alpha-2 receptors will increase the NE release, which will reduce the force of the vasodilation induced by blockade of the alpha-1 receptors. These are useful for patients with pheochromocytoma.
Selective α1 adrenergic antagonists
They cause vasodilation by preventing NE from activating the alpha-1 receptor, resulting in a lowering of the blood pressure, allowing alpha-1 blockers to be used for hypertension. Alpha-1 blockers also cause relaxation of smooth muscle in the prostate, can be useful for the management of benign prostatic hyperplasia (BPH).
Selective α2 adrenergic antagonists
They inhibit negative feedback of NE, stimulating the sympathetic system.
β-Adrenergic Blocking Agents
Mechanism of Action:
These agents blocks the action of substances, such as adrenaline on nerve cells and causes blood vessels to relax and dilate. This allows blood to flow more easily and lowers blood pressure and the heart rate.
Therapeutic Uses:
Beta blockers are used to prevent, treat or improve symptoms in people who have:
Arrhythmia
Heart failure
Chest pain
Heart attacks
Migraine
Certain types of tremors
Adverse Effects:
Asthma
Heart failure
Hypoglycemia
Bradycardia
PH1.28 Describe the mechanisms of action, types, doses, side effects, indicat...Dr Pankaj Kumar Gupta
PH1.28 Describe the mechanisms of action, types, doses, side effects, indications and contraindications of the drugs used in ischemic heart disease (stable, unstable angina and myocardial infarction), peripheral vascular disease
Anti anginal drugs, uses, mechanism of action, adverse effectsKarun Kumar
A presentation outlining the causes of angina, mechanism of action of various anti-anginal drugs, their uses and side effects alongwith contraindications
Hypertension is defined as persistently elevated arterial blood pressure (BP).
JNC7 Guidelines: Seventh Report of the Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure
JNC7 is the national clinical guideline that was developed to aid clinicians in the management of hypertension.
Diuretics
Pharmacology
Katzung
Abnormalities in fluid volume and electrolyte composition are common and important clinical disorders. Drugs that block specific transport functions of the renal tubules are valuable clinical tools in the treatment of these disorders. Although various agents that increase urine volume (diuretics) have been described since antiquity, it was not until 1937 that carbonic anhydrase inhibitors were first described and not until 1957 that a much more useful and powerful diuretic agent (chlorothiazide) became available. Technically, a “diuretic” is an agent that increases urine volume, whereas a “natriuretic” causes an increase in renal sodium excretion and an “aquaretic” increases excretion of solute-free water. Because natriuretics almost always also increase water excretion, they are usually called diuretics. Osmotic diuretics and antidiuretic hormone antagonists (see Agents That Alter Water Excretion) are aquaretics that are not directly natriuretic.
Sympatholytics or Adrenergic AntagonistsAhmad Naeem
Sympatholytics or Adrenergic Antagonists (Introduction, Classification, Alpha Blockers, Beta Blockers Generations, Respirine)
These are drugs which antagonize the receptor action of adrenaline and related drugs.
Mechanism of Action
The adrenergic antagonists (also called adrenergic
blockers or sympatholytics) bind to adrenoceptors but
don’t trigger the usual receptor-mediated intracellular effects.
These drugs act by either reversibly or irreversibly
attaching to the adrenoceptors, thus preventing
activation by endogenous catecholamine's.
Numerous adrenergic antagonists have important
roles in clinical medicine, primarily to treat diseases associated with the cardiovascular system.
α-Adrenergic Blocking Agents
These drugs inhibit adrenergic responses mediated through the α adrenergic receptors without affecting those mediated through β receptors.
Mechanism of action
Drugs that block α adrenoceptors profoundly affect blood pressure. Blockade of these receptors reduces the sympathetic tone of the blood vessels, resulting in decreased peripheral vascular resistance. This induces a reflex tachycardia resulting from the lowered blood pressure.
Non-Selective α adrenergic antagonists
They cause vasodilation by blocking both alpha-1 and alpha-2 receptors. The blockage of alpha-2 receptors will increase the NE release, which will reduce the force of the vasodilation induced by blockade of the alpha-1 receptors. These are useful for patients with pheochromocytoma.
Selective α1 adrenergic antagonists
They cause vasodilation by preventing NE from activating the alpha-1 receptor, resulting in a lowering of the blood pressure, allowing alpha-1 blockers to be used for hypertension. Alpha-1 blockers also cause relaxation of smooth muscle in the prostate, can be useful for the management of benign prostatic hyperplasia (BPH).
Selective α2 adrenergic antagonists
They inhibit negative feedback of NE, stimulating the sympathetic system.
β-Adrenergic Blocking Agents
Mechanism of Action:
These agents blocks the action of substances, such as adrenaline on nerve cells and causes blood vessels to relax and dilate. This allows blood to flow more easily and lowers blood pressure and the heart rate.
Therapeutic Uses:
Beta blockers are used to prevent, treat or improve symptoms in people who have:
Arrhythmia
Heart failure
Chest pain
Heart attacks
Migraine
Certain types of tremors
Adverse Effects:
Asthma
Heart failure
Hypoglycemia
Bradycardia
PH1.28 Describe the mechanisms of action, types, doses, side effects, indicat...Dr Pankaj Kumar Gupta
PH1.28 Describe the mechanisms of action, types, doses, side effects, indications and contraindications of the drugs used in ischemic heart disease (stable, unstable angina and myocardial infarction), peripheral vascular disease
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
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Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
Thesis Statement for students diagnonsed withADHD.ppt
PH1.28 Angina pectoris MANI.ppt
1. Dr. Mani Bharti
Assistant prof.
Department Of Pharmacology
North DMC Medical college &
HRH, Delhi
PH1.28
Describe the mechanisms of action, types, doses, side
effects, indications and contraindications of the
drugs used in ischemic heart disease (stable,
unstable angina and myocardial infarction),
peripheral vascular disease
2. Learning Objectives
• Define angina pectoris & explain the various types of angina pectoris
describing their underlying pathology.
• Classify anti-anginal drugs, describe the mechanism of action,
pharmacological actions, adverse effects and therapeutic uses of nitrates
• Describe the routes of administration, doses and preparations of Nitrates
• Classify Calcium channel blockers, describe the mechanism of action,
pharmacological actions, adverse effects and therapeutic uses of calcium
channel blockers
• Describe the anti-anginal actions, adverse effects and contra-indications to
beta blockers
• Describe the mechanism of action, anti-anginal actions, adverse effects and
the indication for the use of potassium channel openers (nicorandil) in
angina pectoris
• Describe the anti-anginal actions and indications for the use of Ivabradine in
angina pectoris
11. Stable angina:
•Also called “Effort
Angina”
•Discomfort is
precipitated by activity
•Minimal or no
symptoms at rest
•Symptoms disappear
after rest/cessation of
activity
12. Unstable angina:
•Also called “Crescendo
angina”
•Acute coronary syndrome in
which angina worsens
•Occurs at rest
•Severe and of acute onset
•Crescendo pain- pain
increases every time
13.
14. Prinz metal's angina
•Prinz metal's angina is a variant form of angina with
normal coronary vessels or minimal atherosclerosis
•It is probably caused by spasm of coronary artery
15. •Symptoms
•What is the cause of
ischemia ?
either oxygen
demand or oxygen
supply
•Inadequate blood
supply and decreased
oxygen supply are
directly related to
blockade or narrowed
vessels
18. Drugs:
1. For treatment of acute attacks:
Organic nitrates/nitrites
2. For prophylaxis:
Organic nitrates
Beta blockers
Calcium channel blockers
Ranolazine
K+ channel opener- Nicorandil
19.
20.
21. • Heart rate
• Contractility
• Preload
• Afterload
• Coronary flow
• Regional
myocardial blood
flow
O2
D
e
m
a
n
d
O2
S
u
p
p
l
y
-Blockers/Ca2+ channel
blockers
Nitrates/Ca2+ channel
blockers
Nitrates/Ca2+ channel
blockers/antithrombotics/
statins
HEART
24. Organic nitrates
Pro drugs release NO
Levels of intracellular cGMP
Dephosphorylation of mysosin light chain
Cytosolic calcium
Relaxation of smooth muscle
25. •Relaxation of vascular smooth muscles-
vasodilatation
•NO-mediated guanylyl cyclase activation
inhibits platelet aggregation
•Relaxation of smooth muscles of bronchi
and GIT
27. Three different forms of NO synthase are
found in humans:
1. Neuronal NOS (nNOS or NOS1)
2. Inducible NOS (iNOS or NOS2)
3. Endothelial NOS (eNOS or NOS3 or
cNOS) found in endothelium- responsible for
vasodilation
28. CVS Effects:
•Vasodilatation
•Venodilatation decreases venous return
•Decreased chamber size &end-diastolic pressure
•Systemic vascular resistance changes minimally
•Systemic BP may fall slightly
•Dilatation of meningeal vessels can cause
headache
29. •HR-unchanged or may increase slightly
(reflex tachycardia)
•CO slightly reduced
•Even low doses can cause flushing.
•Higher doses-fall in BP
•Reflex tachycardia -restore the systemic BP
30. •Coronary blood flow may initially increase transiently
•Subsequently, due to decreased BP, may decrease
•Nitrates have dilating effect on large coronary vessels
•Increase collateral flow to ischemic areas
•Tend to normalize blood flow to subendocardial
regions of heart- redistribution of blood
•Dilate stenose and reduce vascular resistance in
ischemic areas
31. •Reduction in myocardial O2 consumption is caused by:
Reduced preload
Reduced afterload
in end diastolic volume and LV filling pressure
•In platelets increases cGMP- inhibits aggregation
•Strongest factor for nitrate effect is peripheral pooling
Nitrates infused into coronary artery- no effect
Sublingual- produces effect
32. How myocardial O2 consumption can be determined?
Double product: HR aortic pressure- approximate
measure of myocardial O2 consumption
Triple product: Aortic pressure HR Ejection time-
roughly proportional to myocardial O2 consumption
•Angina occurs at the same value of triple product
with or without nitrates, therefore;
•The beneficial effects of nitrates appear to be due to
decrease in oxygen consumption rather than increase
in oxygen supply
33. Pharmacokinetics:
•High first pass metabolism
•Administered sublingually.
Tolerance:
•Repeated doses lead to tolerance
•Dose spacing is necessary
•Reasons for tolerance:
Capacity of vascular smooth muscle to convert
nitrates to NO – called true vascular tolerance
36. •Headache
May disappear after continued use or,
Decrease dose
•Transient episodes of dizziness, weakness,
pallor etc- symptoms of postural hypotension
•Rash
•PDE5 inhibitor (sildenafil) and nitrates given
simultaneously can produce severe
hypotension
38. Administration of nitrates:
•Sublingual
•Oral: For prophylaxis, require high doses due to first
pass metabolism, isosorbide dinitrate (20 mg or more)
every 4 h or mononitrate (20 mg or more) OD or BD
•Cutaneous:
Ointment (2%) applied to 2.5-5 cm patch of skin
39.
40. Transdermal nitrogycerine discs impregnated with
nitroglycerine polymer- gradual absorption and 24 h
plasma nitrate concentration
Onset is slow
Peak concentration in 1-2 h
Interrupt therapy for at least 8 h a day to prevent
tolerance
47. -Blockers:
Effective in reducing severity and frequency of
exertional angina
May worsen vasospastic angina- contraindicated
Reduce myocardial O2 demand by reducing cardiac
work (-ve iono and chrono effects; decrease in BP
during rest and exercise)
All -blockers are equally effective
48.
49. Nicorandil
Vasodilatory drug used to treat angina pectoris
It has dual properties of a nitrate and ATP
sensitive K+ channel opener
Nitrate action dilates the large coronary arteries
at low plasma concentrations
50. At high concentrations it reduces coronary artery
resistance which is associated with opening of ATP
sensitive K+ channels
Nicorandil has cardioprotective effect which
appears to be due to activation of ATP sensitive K+
channels
ADRs: Flushing, palpitation, headache, mouth
ulcers, nausea and vomiting
51. Ranolazine:
Reserve agent for treatment of chronic, resistant
angina
Inhibits cardiac late Na+ current
Effects the Na+ dependent Ca2+ channels and
prevents Ca2+ overload that causes cardiac
ischemia
52. Decreases cardiac contractility
No change in HR, BP
Prolongs QT interval so it is contraindicated with
drugs that increase QT interval
53. Combination therapy
Nitrates and β-adrenoceptors blockers.
Calcium channel blockers and β-adrenoceptor
blockers .? ?
Calcium channel blockers and nitrates.
Calcium channel blockers, β-adrenoceptor
blockers, nitrates.
54.
55. DRUG THERAPY IN MYOCARDIAL INFARCTION
• According to severity, the acute coronary syndromes (ACS) may be
graded into:
• Unstable angina (UA): Vascular obstruction is incomplete,
• Non-ST segment elevation myocardial infarction (NSTEMl): Vascular
obstruction is incomplete, but is attended by partial thickness and
relatively smaller area or myocardial necrosis; biochemical markers
appear in blood, but ST segment is not elevated.
• ST segment elevation myocardial infarction (STEM/) : Vascular
obstruction is complete, full thickness of ventricular wall and larger
area of myocardium is necrosed, biochemical markers are prominent
and ST segment in ECG is elevated.
56. • I. Pain, anxiety and apprehension- After pain is not relieved by 3
doses of GTN given 5 min apart, an opioid analgesic (morphine) or
diazepam is administered parenterally.
• 2. Oxygenation- By 02 inhalation and assisted respiration, if needed.
3. Maintenance of blood volume, tissue perfusion and
microcirculation -Slow i.v. infusion of saline/dextrose (avoid volume
overload).
• 4. Correction of acidosis- Acidosis occurs due to lactic acid
production; can be corrected by i.v. sod. bicarbonate infusion.
• 5. Prevention and treatment of arrhythmias- If there are no
contraindications, prophylactic administration (i.v. or oral) of a beta
blocker
57. 6. Pump failure-
(a)Furosemide: indicated if pulmonary wedge pressure is >
20 mm [ lg. It decreases cardiac pre load.
(b)Vasodilators: Venodilator (GTN slow i.v infusion) is
mainly used.
(c)inotropic agents: dopamine or dobutamine
7. Prevention of thrombus extension, embolism, venous
thrombosis-
• Aspirin ( 162- 325 mg). This is continued at 80- 160
mg/day.
• Clopidogrel/ prasugrel/ticagrelor may be given as
alternative.
• Anticoagulants (heparin/fondaparinux followed by oral
anticoagulants)
58. 8. Thrombolysis and reperfusion- Fibrinolytic agents,
i.e. plasminogen activators- alteplase/ tenecteplase to
achieve reperfusion of reinfarcted area
9. Prevention of remodeling and subsequent CHF ACE
inhibitors/ARBs
10. Prevention of future attacks
(a) Plate let inhibitors aspirin or clopidogrel
(b) blockers-
(c) Control of hyperlipidemia-dietary substitution
with unsaturated fats, hypolipidemic drugs
especially statins are routinely prescribed,
irrespective of blood cholesterol level.
61. DRUGS FOR PERIPHERAL VASCULAR DISEASE
Pentoxiphylline (oxypentifylline):
MOA- inhibits phospho-diesterase enzyme.
It is a blood viscosity reducing agent and improves blood flow in ischaemic
area through microcirculation.
Oral doses do not affect HR, total peripheral resistance and BP. It does not
exhibit "coronary steal phenomenon". However, the overall benefits in
anginal patients are only limited.
Its other uses are
To reduce peripheral claudication, non-haemorrhagic stroke; chronic
cerebrovascular insufficiency; to improve symptoms like vertigo and
memory
62. Side effects -are mild and well tolerated.
Dose: 400 mg BD orally.
Drug interactions: It may increase anticoagulatory
effects of warfarin and may increase serum levels
of theophylline.
Other therapies include: Cilostazole,
Naftidofuryl (SHT2, receptor antagonist) and
Levo-Carnitine -(which improves the metabolic
status of skeletal muscle).
These can be supplemented with statins for more
beneficial results