Archive for the ‘ L4-Pharma Angina ’ Category

L4- Pharmacology of Angina Pectoris

HEART  METABOLISM IN  ISCHAEMIA

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TYPES  OF ANGINA

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TREATMENT  OF  ANGINA

•GENERAL MEASURES & LIFESTYLE  MODIFICATION

•DRUG THERAPY

•SURGERY

GENERAL  MEASURES

•LIFE  STYLE  MODIFICATION

•CORRECT  OBESITY & REDUCE  FAT INTAKE

•TREATMENT  OF PREDISPOSING FACTORS

DRUGS

DURING  ACUTE ATTACK ( Relief of pain)

•Short  acting  nitrites & nitrates

•Sedative  &  analgesic

IN  BETWEEN:

•Long  acting  nitrates or Nicorandil (K Channel activator)

•B.B. (non selective) or CCB (e.g. Diltiazem, Amlodipine)

•Cytoprotective  drugs

•Antiplatelet (e.g.Aspirin)

•Cholesterol lowering drug (e.g. Statin)

ORGANIC  NITRITES  &  NITRATES (Are esters of nitrous acid & nitric acid)

PH.K.  Of  nitrites  &  nitrates

•Readily  absorbed

•High 1st pass  of  Dinitrate  & Tetranitrate

•Low 1st pass  of Mononitrate

•Renal  excretion

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Antianginal mechanism of Nitrites:

1. Coronary  dilator

2. Venodilator mainly Cardiac Output  &  Work  decrease

CORONARY  DILATOR  MECHANISM  OF  NITRITES  & NITRATES

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PHARMACOLOGICAL  EFFECTS

CVS:

•Coronary  dilator Venodilator mainly

•Cardiac Output  &  Work  decrease Tachycardia

•B.P.  Decrease  (with high dose rapid adm.)

Smooth muscle  relaxation

Tachypnea

Methaemoglobinaemia

USES  OF  NITRITES

•Angina   pectoris  ( mechanism  ? ) / CHF M / Infarction

•Biliary  Colic

•Uterine Constriction  ring

•Cyanide  poisoning  ( mechanism  ? )

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ADVERSE  EFFECTS  OF NITRITES

•Throbbing  headache

•Postural hypotension, syncope

•Tachycardia

•Flushing

•Methaemoglobinaemia  (rarely) •Tolerance   ???

Nitrite   tolerance

•More  with  mononitrate

•Mechanism:

(1) Depletion  of SH  donors

(2) Reflex  VC  &  Sod.  Retention

•Prevented  by:  nitrate-free interval (12hrs)

PRECAUTIONS  OF  NITRITES

•Start by the smallest  dose

•Stop gradually

•Consultation:15  min  failure of sublingual tab.

•Sunlight exposure  of nitroglycerine

•Cotton & other drug together keeping

•Expiry date

BETA  BLOCKERS  IN  ANGINA (Not variant Angina)

Decrease  HR

Coronary redistribution

Cytoprotection

Balance the deleterious effects of nitrites

AVOID  SUDDEN  CESSATION  ?
BB –NITRATES  COMBINATION
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ADVERSE EFFECTS  & PRECAUTIONS OF B.B

HT.F,BRADYCARDIA,HYPOTENSION

BRONCHOSPASM

#  INSULIN

PERIPHERAL ISCHEMIA HYPERKALAEMIA IN….

  1. Inc. TRIGLYCERIDES,
  2. Dec. HDL
  3. DETERIORATION  WITH SUDDEN WITHDRAWAL

CALCIUM CHANNEL BLOCKERS

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CCBs  in ANGINA ( all  types )

Decrease BP & M. contractility (Amlodipine & Diltiazem)

Coronary dil.

Cytoprotection

THERAPEUTIC  USES  OF  CCB

•Ischaemic Ht. Diseases

•Arrhythmias

•AHT

•Cerebral vasospasm & Peripheral  vascular disease

Contraindications &Precautions CCBs:

•HF

•A.V. block

•Sick sinus S.

•WPWS

•Low BP

•Unstable angina (NIFEDIPINE)

CYTOPROTECTIVE AGENT

HYPOXIA

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Trimetazidine

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Trimetazidine   Mechanism

•Provide  enough  energy for  efficient contraction

•Limits cellular acidosis  & Ca  accumulation

•Limits  membrane  damage by free radical

ASPIRIN (Antithrombotic)

ANTI-ANGINAL  OF  CHOICE

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