drugs for angina
Content
ANTIANGINAL DRUGS O2 supply is delivered via coronary arteries
NITRATES AND NITRITES A. Dilates all blood vessels B. INDICATION: Long-acting dosage forms for prevention of angina episodes C. CONTRAINDICATION: anemia, drug allergy, closed-angle glaucoma, hypotension, and severe head injury D. ADVERSE EFFECTS: reflex tachycardia 1. Rarity is methemoglobinemia E. INTERACTION: produces hypotensive effects with alcohol, B-blockers, CCBs, phenothiazines, and erectile-dysfunction drugs ISOSORBIDE DINITRATE A. Organic nitrate and a powerful explosive B. Metabolized in the liver, thus into 2 metabolites C. Comes in sublingual rapid-acting, immediate-release tabs, and long-acting oral forms ISOSORBIDE MONONITRATE A. One of the 2 active metabolites of its dinitrate, but has no active metabolites B-BLOCKERS (Atenolol and Metoprolol) A. Coronary arteries receive increasingly less blood and eventually the myocardium becomes ischemic 1. Increases O2 demand from increase in systole B. Slows conduction via AV node and reduce myocardial contractility C. They also suppress hormone rennin, a potent vasoconstrictor released by kidneys D. INDICATIONS: for exertional angina, MI, hypertension, dysrhythmias, and tremors E. CONTRAINDICATIONS: bronchial asthma, reduced mental alertness, PVD, diabetes Ca+ CHANNEL BLOCKERS (CCBs) A. 3 chemical classes: 1. Phenylalkylamines 2. Benzothiazepines 3. Dihydropyridines B. Decreases workload and reduces myocardial oxygen demand; depression of automaticity C. Considered to be 1st line drugs for TX of angina, hypertension and supraventricular tachycardia and for short-term atrial fibrillation D. CONTRAINDICATION: acute MI, 2nd or 3rd degree AV block, hypotension DILTIAZEM A. Very effective for angina pectoris from coronary insufficiency and hypertension B. Used for atrial fibrillation and flutter with paroxysmal supraventricular tachycardia AMLODIPINE A. The most popular CCB RANOLAZINE A. Newest available approved by FDA 2006 for chronic angina B. Known to prolong QT interval of ECG C. CONTRAINDICATION: preexisting QT prolongation or hepatic impairment D. Also raises digoxin levels enough to require digoxin dose adjustments
NITRATES AND NITRITES A. Dilates all blood vessels B. INDICATION: Long-acting dosage forms for prevention of angina episodes C. CONTRAINDICATION: anemia, drug allergy, closed-angle glaucoma, hypotension, and severe head injury D. ADVERSE EFFECTS: reflex tachycardia 1. Rarity is methemoglobinemia E. INTERACTION: produces hypotensive effects with alcohol, B-blockers, CCBs, phenothiazines, and erectile-dysfunction drugs ISOSORBIDE DINITRATE A. Organic nitrate and a powerful explosive B. Metabolized in the liver, thus into 2 metabolites C. Comes in sublingual rapid-acting, immediate-release tabs, and long-acting oral forms ISOSORBIDE MONONITRATE A. One of the 2 active metabolites of its dinitrate, but has no active metabolites B-BLOCKERS (Atenolol and Metoprolol) A. Coronary arteries receive increasingly less blood and eventually the myocardium becomes ischemic 1. Increases O2 demand from increase in systole B. Slows conduction via AV node and reduce myocardial contractility C. They also suppress hormone rennin, a potent vasoconstrictor released by kidneys D. INDICATIONS: for exertional angina, MI, hypertension, dysrhythmias, and tremors E. CONTRAINDICATIONS: bronchial asthma, reduced mental alertness, PVD, diabetes Ca+ CHANNEL BLOCKERS (CCBs) A. 3 chemical classes: 1. Phenylalkylamines 2. Benzothiazepines 3. Dihydropyridines B. Decreases workload and reduces myocardial oxygen demand; depression of automaticity C. Considered to be 1st line drugs for TX of angina, hypertension and supraventricular tachycardia and for short-term atrial fibrillation D. CONTRAINDICATION: acute MI, 2nd or 3rd degree AV block, hypotension DILTIAZEM A. Very effective for angina pectoris from coronary insufficiency and hypertension B. Used for atrial fibrillation and flutter with paroxysmal supraventricular tachycardia AMLODIPINE A. The most popular CCB RANOLAZINE A. Newest available approved by FDA 2006 for chronic angina B. Known to prolong QT interval of ECG C. CONTRAINDICATION: preexisting QT prolongation or hepatic impairment D. Also raises digoxin levels enough to require digoxin dose adjustments
