SlideShare a Scribd company logo
1 of 24
Download to read offline
Angina pectoris
Sudden,severe,pressing chest pain
starting substernal &radiate to left
arm.
Due to imbalance between
myocardium oxygen requirement
and oxygen supply.
Risk factors :
Age,sex,obesity.smoking,diabetes.
Classification of angina
1. Exertional angina,
Stable,Atherosclerotic,Classic,
Due to obstruction of coronaries by
atheroma.
2. Variant, Vasospastic angina
due to Spasm of coronaries.
3- Unstable angina.
Due to spasm and partial obstruction of
coronaries.
Nitrates & Nitrites
Preparations :
1- Short acting:
Start within few minutes and total duration
of action 15-30 minutes.
A) Nitroglycerine (Glyceryl trinitrate)
Used as sublingual tablets.
B) Isosorbide dinitrate
As sublingual spray.
C) Amyl nitrite
Inhalation
2- Long acting
Nitroglycerine, Isosorbide dinitrate,
Isosorbide mononitrate,Erythrityl –
Tetranitrate.
Action of all start withen hours and
continue for hours .
They are given :
Orally,Ointment,Buccal,Transdermal
patch,Parenteral.
Absorption
Well absorbed according to the route:
GIT for the long acting
short acting Sublingual
Transdermal for long acting
inhaLation
Metabolism
Through first pass hepatic metabolism .
Short acting have a low oral bioavailability
(10-20%),so not given orally to avoid first
pass metabolism.
Nitroglycerine metabolites( two dinitro And
two mononitro forms).
The dinitro forms are active metabolites
and have significant vasodilator effect.
Metabolism
Isosorbide dinitrate metabolite (5-
mononitrate) is an active metabolite
used clinically.
Excretion
As metabolites through kidney.
Mechanism of action
Glutathione S-transferase
Nitroglycerine ————————→
No.
guanylyl cyclase and NO activates
increase c GMP
c GMP dephosphorelate myosin light
chain (Myosin-LC-po4 ) to myosin- LC
Causing muscle relaxation.
Pharmacological actions
Nitrates relax all types of smooth muscles
vascular or non vascular .
Relax both arteries and veins but more
effective on veins.
They have no direct effect on cardiac or
skeletal muscles.
NO released stimulate guanylyl cyclase
In platelets causing increase cGMP that
decrease platelet aggregation.
Clinical uses
Short acting for acute attacks
Long acting for prophylactic.
Treatment of all types of angina .
1- Angina of effort
A) Decrease venous return
B) Decrease ABP
Both A&B decrease myocardial
oxygen requirement.
2-Variant angina
Relax smooth muscle of epicardial
coronary artery and relief coronary
spasm.
Unstable angina
 Decrease myocardial oxygen
requirement.
Relief coronary spasm.
Decrease platelet aggregation.
Adverse effects
Orthostatic hypotension
Throbbing headache
Tachycardia
Facial or cutaneous flushing
Tolerance (Tachyphylaxis)
Salt and water retention
Carcinogenicity
Methaemoglobinemia only with nitrities
Contraindication
Nitrates are contraindicated in
increase intracranial pressure.
Nitrates can be used safely in
increase of intraocular pressure
(Glucoma).
Calcium channel blockers
1- They block calcium entry in
myocardium causing ;
A) decrease myocardium
contractility & myocardium
oxygen requirement.
B) decrease heart rate causing
decrease in myocardium oxygen
requirement.
2-Block calcium entry in vascular
smooth muscles (arterioles) causing
a)decrease in peripheral
resistance( after load)------ decrease
in oxygen requirement.
• b)Relief of coronary spasm.
Clinical uses
In all types of angina but very
effective in variant angina .
Used mainly in prophylactic therapy.
β-Adrenoceptor blocking
drugs
They are not vasodilators
They are used in treatment of
angina :
They decrease both heart rate &
myocardial contractility that
decrease in myocardial oxygen
requirement at rest & in exercise so
improve exercise tolerance.
Clinical uses
They are effective in the prophylactic
treatment of classic & unstable angina.
They are not used in variant angina.
They are effective in treatment of silent or
ambulatory angina (no pain ).
Decrease mortality of patients with recent
myocardial infarction.
Potassium channel openers
(Nicorandil )
Activation of potassium channels.
Nitric oxide release.
Arterio & venodilators.
Used as prophylactic therapy .
May cause :
Headache,flushing,dizziness.
Drug treatment of angina
1- Acute attack :
Short acting nitrates or nitritis.
2- Prophylactic therapy ;
Long –acting nitrates.
Calcium channel blockers.
β- adrenoceptors blockers.
Potassium channel openers.
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.
Surgical therapy
Ballon
Coronary by pass.

More Related Content

What's hot (19)

Angina Pectoris
Angina PectorisAngina Pectoris
Angina Pectoris
 
Angina pectoris
Angina pectorisAngina pectoris
Angina pectoris
 
Angina pectoris
Angina pectorisAngina pectoris
Angina pectoris
 
Angina pectoris : causes, symptoms, diagnosis and treatment
Angina pectoris : causes, symptoms, diagnosis and treatmentAngina pectoris : causes, symptoms, diagnosis and treatment
Angina pectoris : causes, symptoms, diagnosis and treatment
 
angina pectoris ppt
 angina pectoris  ppt angina pectoris  ppt
angina pectoris ppt
 
Angina pectoris
Angina pectorisAngina pectoris
Angina pectoris
 
Angina pectoris presentation
Angina pectoris presentationAngina pectoris presentation
Angina pectoris presentation
 
Angina pectoris
Angina pectorisAngina pectoris
Angina pectoris
 
Angina pectoris
Angina pectorisAngina pectoris
Angina pectoris
 
Angina pectoris by student at ahram canadian university
Angina pectoris by student at ahram canadian universityAngina pectoris by student at ahram canadian university
Angina pectoris by student at ahram canadian university
 
Angina pectoris
Angina pectorisAngina pectoris
Angina pectoris
 
Angina
AnginaAngina
Angina
 
Angina pectoris
Angina pectorisAngina pectoris
Angina pectoris
 
Pharmacotherapy of stable angina
Pharmacotherapy of stable anginaPharmacotherapy of stable angina
Pharmacotherapy of stable angina
 
Ischemic heart disease
Ischemic heart disease Ischemic heart disease
Ischemic heart disease
 
Angina Pectoris
Angina PectorisAngina Pectoris
Angina Pectoris
 
Angina pectoris
Angina pectorisAngina pectoris
Angina pectoris
 
Angina pectoris ppt
Angina pectoris ppt Angina pectoris ppt
Angina pectoris ppt
 
Angina Pectoris
Angina Pectoris Angina Pectoris
Angina Pectoris
 

Viewers also liked

Viewers also liked (14)

Angina pectoris ppt
Angina pectoris pptAngina pectoris ppt
Angina pectoris ppt
 
Angina pectoris presentation
Angina pectoris presentationAngina pectoris presentation
Angina pectoris presentation
 
Acute Left Ventricular Failure
Acute Left Ventricular FailureAcute Left Ventricular Failure
Acute Left Ventricular Failure
 
Cerebral Malaria
Cerebral Malaria Cerebral Malaria
Cerebral Malaria
 
Microalbuminuria
MicroalbuminuriaMicroalbuminuria
Microalbuminuria
 
Acute respiratory failure
Acute respiratory failureAcute respiratory failure
Acute respiratory failure
 
Acute Respiratory Failure
Acute Respiratory FailureAcute Respiratory Failure
Acute Respiratory Failure
 
Cerebral malaria
Cerebral malariaCerebral malaria
Cerebral malaria
 
Cerebral malaria
Cerebral  malariaCerebral  malaria
Cerebral malaria
 
Left Ventricular Failure: Heart Failure
Left Ventricular Failure: Heart FailureLeft Ventricular Failure: Heart Failure
Left Ventricular Failure: Heart Failure
 
Angina pectoris
Angina pectorisAngina pectoris
Angina pectoris
 
Management of acute lvf
Management of acute lvfManagement of acute lvf
Management of acute lvf
 
Cardiac tamponade
Cardiac tamponade Cardiac tamponade
Cardiac tamponade
 
Acute left ventricular failure
Acute left ventricular failureAcute left ventricular failure
Acute left ventricular failure
 

Similar to Angina pectoris (20)

angina and IHD -AHS by Gowtham sap
angina and IHD -AHS by Gowtham sap angina and IHD -AHS by Gowtham sap
angina and IHD -AHS by Gowtham sap
 
angina ppt.ppt
angina ppt.pptangina ppt.ppt
angina ppt.ppt
 
03. Angina pectoris.ppt
03. Angina pectoris.ppt03. Angina pectoris.ppt
03. Angina pectoris.ppt
 
Antianginals - pharmacology
Antianginals - pharmacologyAntianginals - pharmacology
Antianginals - pharmacology
 
ANGINA DRUGS BY EXA.pptx
ANGINA DRUGS BY EXA.pptxANGINA DRUGS BY EXA.pptx
ANGINA DRUGS BY EXA.pptx
 
ANGINA DRUGS BY EXA.pptx
ANGINA DRUGS BY EXA.pptxANGINA DRUGS BY EXA.pptx
ANGINA DRUGS BY EXA.pptx
 
Pharmacology angina
Pharmacology   anginaPharmacology   angina
Pharmacology angina
 
14.antianginal drugs
14.antianginal drugs14.antianginal drugs
14.antianginal drugs
 
14.antianginal drugs
14.antianginal drugs 14.antianginal drugs
14.antianginal drugs
 
Anti-Angina & Anti arryhthias Drugs .ppt
Anti-Angina & Anti arryhthias Drugs .pptAnti-Angina & Anti arryhthias Drugs .ppt
Anti-Angina & Anti arryhthias Drugs .ppt
 
PH1.28 Angina pectoris MANI.ppt
PH1.28 Angina pectoris MANI.pptPH1.28 Angina pectoris MANI.ppt
PH1.28 Angina pectoris MANI.ppt
 
Antianginal drugs and drugs used in ischaemia - drdhriti
Antianginal drugs and drugs used in ischaemia - drdhritiAntianginal drugs and drugs used in ischaemia - drdhriti
Antianginal drugs and drugs used in ischaemia - drdhriti
 
CVS-_Angina_Pectoris.pdf
CVS-_Angina_Pectoris.pdfCVS-_Angina_Pectoris.pdf
CVS-_Angina_Pectoris.pdf
 
Anti anginal drugs ppt by anjali kotwal
Anti  anginal drugs ppt by anjali kotwalAnti  anginal drugs ppt by anjali kotwal
Anti anginal drugs ppt by anjali kotwal
 
Antianginal Drugs
Antianginal DrugsAntianginal Drugs
Antianginal Drugs
 
Antianginal Drugs a
Antianginal Drugs aAntianginal Drugs a
Antianginal Drugs a
 
Antianginal Drugs
Antianginal DrugsAntianginal Drugs
Antianginal Drugs
 
Antianginal Drugs
Antianginal DrugsAntianginal Drugs
Antianginal Drugs
 
2 Drugs for IHD.pptx
2 Drugs for IHD.pptx2 Drugs for IHD.pptx
2 Drugs for IHD.pptx
 
2 Drugs for IHD.pptx
2 Drugs for IHD.pptx2 Drugs for IHD.pptx
2 Drugs for IHD.pptx
 

Recently uploaded

Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyMedicoseAcademics
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismusChandrasekar Reddy
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptPradnya Wadekar
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.kishan singh tomar
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communicationskatiequigley33
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...Shubhanshu Gaurav
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE Mamatha Lakka
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfPAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfDolisha Warbi
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyZurück zum Ursprung
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfHongBiThi1
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologyDeepakDaniel9
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondSujoy Dasgupta
 

Recently uploaded (20)

Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before Pregnancy
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismus
 
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.ppt
 
Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communications
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfPAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturally
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacology
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and Beyond
 

Angina pectoris

  • 1. Angina pectoris Sudden,severe,pressing chest pain starting substernal &radiate to left arm. Due to imbalance between myocardium oxygen requirement and oxygen supply. Risk factors : Age,sex,obesity.smoking,diabetes.
  • 2. Classification of angina 1. Exertional angina, Stable,Atherosclerotic,Classic, Due to obstruction of coronaries by atheroma. 2. Variant, Vasospastic angina due to Spasm of coronaries. 3- Unstable angina. Due to spasm and partial obstruction of coronaries.
  • 3. Nitrates & Nitrites Preparations : 1- Short acting: Start within few minutes and total duration of action 15-30 minutes. A) Nitroglycerine (Glyceryl trinitrate) Used as sublingual tablets. B) Isosorbide dinitrate As sublingual spray. C) Amyl nitrite Inhalation
  • 4. 2- Long acting Nitroglycerine, Isosorbide dinitrate, Isosorbide mononitrate,Erythrityl – Tetranitrate. Action of all start withen hours and continue for hours . They are given : Orally,Ointment,Buccal,Transdermal patch,Parenteral.
  • 5. Absorption Well absorbed according to the route: GIT for the long acting short acting Sublingual Transdermal for long acting inhaLation
  • 6. Metabolism Through first pass hepatic metabolism . Short acting have a low oral bioavailability (10-20%),so not given orally to avoid first pass metabolism. Nitroglycerine metabolites( two dinitro And two mononitro forms). The dinitro forms are active metabolites and have significant vasodilator effect.
  • 7. Metabolism Isosorbide dinitrate metabolite (5- mononitrate) is an active metabolite used clinically. Excretion As metabolites through kidney.
  • 8. Mechanism of action Glutathione S-transferase Nitroglycerine ————————→ No. guanylyl cyclase and NO activates increase c GMP c GMP dephosphorelate myosin light chain (Myosin-LC-po4 ) to myosin- LC Causing muscle relaxation.
  • 9. Pharmacological actions Nitrates relax all types of smooth muscles vascular or non vascular . Relax both arteries and veins but more effective on veins. They have no direct effect on cardiac or skeletal muscles. NO released stimulate guanylyl cyclase In platelets causing increase cGMP that decrease platelet aggregation.
  • 10. Clinical uses Short acting for acute attacks Long acting for prophylactic. Treatment of all types of angina .
  • 11. 1- Angina of effort A) Decrease venous return B) Decrease ABP Both A&B decrease myocardial oxygen requirement.
  • 12. 2-Variant angina Relax smooth muscle of epicardial coronary artery and relief coronary spasm.
  • 13. Unstable angina  Decrease myocardial oxygen requirement. Relief coronary spasm. Decrease platelet aggregation.
  • 14. Adverse effects Orthostatic hypotension Throbbing headache Tachycardia Facial or cutaneous flushing Tolerance (Tachyphylaxis) Salt and water retention Carcinogenicity Methaemoglobinemia only with nitrities
  • 15. Contraindication Nitrates are contraindicated in increase intracranial pressure. Nitrates can be used safely in increase of intraocular pressure (Glucoma).
  • 16. Calcium channel blockers 1- They block calcium entry in myocardium causing ; A) decrease myocardium contractility & myocardium oxygen requirement. B) decrease heart rate causing decrease in myocardium oxygen requirement.
  • 17. 2-Block calcium entry in vascular smooth muscles (arterioles) causing a)decrease in peripheral resistance( after load)------ decrease in oxygen requirement. • b)Relief of coronary spasm.
  • 18. Clinical uses In all types of angina but very effective in variant angina . Used mainly in prophylactic therapy.
  • 19. β-Adrenoceptor blocking drugs They are not vasodilators They are used in treatment of angina : They decrease both heart rate & myocardial contractility that decrease in myocardial oxygen requirement at rest & in exercise so improve exercise tolerance.
  • 20. Clinical uses They are effective in the prophylactic treatment of classic & unstable angina. They are not used in variant angina. They are effective in treatment of silent or ambulatory angina (no pain ). Decrease mortality of patients with recent myocardial infarction.
  • 21. Potassium channel openers (Nicorandil ) Activation of potassium channels. Nitric oxide release. Arterio & venodilators. Used as prophylactic therapy . May cause : Headache,flushing,dizziness.
  • 22. Drug treatment of angina 1- Acute attack : Short acting nitrates or nitritis. 2- Prophylactic therapy ; Long –acting nitrates. Calcium channel blockers. β- adrenoceptors blockers. Potassium channel openers.
  • 23. 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.