Drugs used in the treatment of angina, UTHSC
Spring 2023 D2 Pharmacology
What drug types do we use for ischemic heart disease?
beta blockers, calcium channel blockers, nitrous drugs
Nitrous drugs for IHD
nitrous oxide
beta blockers for IHD
end in -olol
Calcium channel blockers for IHD
end in -ipine
- verampamel
- Diltiazem
What is angina?
- lack of sufficient oxygen (ischemia) to the heart, causes pain, "angina."
What are the symptoms of angina?
- retrosternal, radiates to arms, neck, or jaw
- pressure sensation, "weight"
- new onest or worsened exertional dyspnea
What causes angina?
imbalance between oxygen delivery and utilization
Stable (exertional) angina
coronary circulation can meet oxygen demands of heart at rest but not when hear work
increased by exercise (exertional angina) due to atherosclerosis
unstable angina
plaque rupture results in thrombosis, blocks blood flow
myocardial infarction
platelet thrombus completely blocks blood flow to heart muscle
variant or Prinzmetal angina
Vasospasm blocks blood flow (vasospasm can also contribute to other forms of angina)
What are the signs of stable exertional angina?
-- stable frequency of pain
-- predictable: occurs with similar exertion level
--relieved by rest and/or nitrates
--transient ecg changes
What are the signs of unstable angina?
-- pain occurs at rest or with minimal exertion
-- persistent pain (> 10 minutes)
-- pain occurs with increasing frequency
-- new nocturnal pain
-- associated symptoms of diaphoresis, dyspnea, abdominal pain or syncope
What are some symptoms that will help us determine a patient is having pain due
to coronary heart disease?
- prior history of angina
- chest pain radiates to arm or jaw
, - Heart rate is normal or slightly elevated
- Presence of diaphoresis (sweating) or nausea
Your patient experiences chest discomfort during a dental procedure. He
describes the discomfort as a squeezing tightness or heavy weight in the center
of his chest. You recognize that these symptoms can be caused by many
conditions including several non-cardiac conditions such as gastroesophageal
reflux, costochondritis and anxiety or arrhythmias. Which of the following would
increase the likelihood these symptoms are due to coronary heart disease?
A. Prior history of angina
B. Chest pain radiates to either arm or jaw
C. Heart rate is normal or slightly elevated
D. Presence of diaphoresis (sweating) or nausea.
E. All of the above
E. All of the above
What are the three approaches for treating angina?
1. increase coronary blood flow (nitroglycerin)
2. Reduce myocardial oxygen consumption (mvo2)
3. Prevent platelet deposition/aggregation
What are the ways we can reduce myocardial oxygen consumption?
- reduce heart rate
- reduce myocardial contractility
- decrease wall stress: reduce preload/afterload
What are the Red Light drugs that we know are for preventing platelet
deposition/aggregation?
aspirin, Clopidogrel, Prasugrel, Ticagrelor
Nitrate Chemistry
Polyol esters of nitric acid, -C-O-NO2 (nitroglycerin). Organic nitrites are polyol esters of
nitrous acid, -C-O-NO (Amyl Nitrite). Amyl nitrite is highly volatile and is administered by
inhalation. Nitroglycerin is a moderately volatile oily liquid.
What are the two mechanisms Nitrates use to produce antianginal effects?
- venodilation resulting in decreased preload
- Coronary vasodilation
What effects does nitrate causing venodilation have?
- decreased pressure during diastole in ventricles of heart
- reduced wall stress and MvO2
- subendocardial blood flow is increased
What effects does nitrate causing coronary vasodilation have?
- redistribution of blood flow to areas of ischemia
- Selective dilatation of epicardial and collateral coronary vessels.
- prevents or reverses coronary vasospasm
Rapid hepatic metabolism presents a therapeutic problem for nitrates. What are
some potential solutions to this problem?
- Bypass enterohepatic circulation (oral mucosa)
- Bypass enterohepatic circulation (cutaneous or intravenous delivery)
- Reduce metabolism and saturate liver enzyme (hepatic nitrate reductase)
Spring 2023 D2 Pharmacology
What drug types do we use for ischemic heart disease?
beta blockers, calcium channel blockers, nitrous drugs
Nitrous drugs for IHD
nitrous oxide
beta blockers for IHD
end in -olol
Calcium channel blockers for IHD
end in -ipine
- verampamel
- Diltiazem
What is angina?
- lack of sufficient oxygen (ischemia) to the heart, causes pain, "angina."
What are the symptoms of angina?
- retrosternal, radiates to arms, neck, or jaw
- pressure sensation, "weight"
- new onest or worsened exertional dyspnea
What causes angina?
imbalance between oxygen delivery and utilization
Stable (exertional) angina
coronary circulation can meet oxygen demands of heart at rest but not when hear work
increased by exercise (exertional angina) due to atherosclerosis
unstable angina
plaque rupture results in thrombosis, blocks blood flow
myocardial infarction
platelet thrombus completely blocks blood flow to heart muscle
variant or Prinzmetal angina
Vasospasm blocks blood flow (vasospasm can also contribute to other forms of angina)
What are the signs of stable exertional angina?
-- stable frequency of pain
-- predictable: occurs with similar exertion level
--relieved by rest and/or nitrates
--transient ecg changes
What are the signs of unstable angina?
-- pain occurs at rest or with minimal exertion
-- persistent pain (> 10 minutes)
-- pain occurs with increasing frequency
-- new nocturnal pain
-- associated symptoms of diaphoresis, dyspnea, abdominal pain or syncope
What are some symptoms that will help us determine a patient is having pain due
to coronary heart disease?
- prior history of angina
- chest pain radiates to arm or jaw
, - Heart rate is normal or slightly elevated
- Presence of diaphoresis (sweating) or nausea
Your patient experiences chest discomfort during a dental procedure. He
describes the discomfort as a squeezing tightness or heavy weight in the center
of his chest. You recognize that these symptoms can be caused by many
conditions including several non-cardiac conditions such as gastroesophageal
reflux, costochondritis and anxiety or arrhythmias. Which of the following would
increase the likelihood these symptoms are due to coronary heart disease?
A. Prior history of angina
B. Chest pain radiates to either arm or jaw
C. Heart rate is normal or slightly elevated
D. Presence of diaphoresis (sweating) or nausea.
E. All of the above
E. All of the above
What are the three approaches for treating angina?
1. increase coronary blood flow (nitroglycerin)
2. Reduce myocardial oxygen consumption (mvo2)
3. Prevent platelet deposition/aggregation
What are the ways we can reduce myocardial oxygen consumption?
- reduce heart rate
- reduce myocardial contractility
- decrease wall stress: reduce preload/afterload
What are the Red Light drugs that we know are for preventing platelet
deposition/aggregation?
aspirin, Clopidogrel, Prasugrel, Ticagrelor
Nitrate Chemistry
Polyol esters of nitric acid, -C-O-NO2 (nitroglycerin). Organic nitrites are polyol esters of
nitrous acid, -C-O-NO (Amyl Nitrite). Amyl nitrite is highly volatile and is administered by
inhalation. Nitroglycerin is a moderately volatile oily liquid.
What are the two mechanisms Nitrates use to produce antianginal effects?
- venodilation resulting in decreased preload
- Coronary vasodilation
What effects does nitrate causing venodilation have?
- decreased pressure during diastole in ventricles of heart
- reduced wall stress and MvO2
- subendocardial blood flow is increased
What effects does nitrate causing coronary vasodilation have?
- redistribution of blood flow to areas of ischemia
- Selective dilatation of epicardial and collateral coronary vessels.
- prevents or reverses coronary vasospasm
Rapid hepatic metabolism presents a therapeutic problem for nitrates. What are
some potential solutions to this problem?
- Bypass enterohepatic circulation (oral mucosa)
- Bypass enterohepatic circulation (cutaneous or intravenous delivery)
- Reduce metabolism and saturate liver enzyme (hepatic nitrate reductase)
