The Cardiovascular Drugs
,Antianginal Drugs
,Angina Pectoris (chest pain)
When the supply of oxygen and nutrients in the blood is insufficient to meet the
demands of the heart, the heart muscle “aches.”
The heart requires a large supply of oxygen to meet the demands placed on it.
Ischemia
Ischemia
Poor blood supply to an organ
Ischemic heart disease
Poor blood supply to the heart muscle
Atherosclerosis
Coronary artery disease
Myocardial infarction
Necrosis, or death, of cardiac tissue
Disabling or fatal
Type of angina
Chronic stable angina (also called classic or effort angina)
Unstable angina (also called preinfarction angina)
Vasospastic angina (also called Prinzmetal or variant angina)
Goal of medical management
• Minimize the frequency, decrease the durations and intensity of angina attacks
• Improve functional capacity with few adverse effects
• Prevent or delay MI
A person who is mowing the lawn on a hot Saturday afternoon begins to notice chest
pain. What should this person’s first action be? A. Take a nitroglycerin tablet.
B. Stop mowing and sit or lie down.
C. Go inside the house to cool off and get a drink of water.
D. Call 911.
Correct answer: B
Rationale: At the first sign of chest pain, the person should stop all activity and sit or lie
down before taking the nitroglycerin tablet.
Drugs for Angina
Nitrates and nitrites ß-
Blockers
, Calcium channel blockers
Nitrates and Nitrites
Available forms
Sublingual*
Chewable tablets
Oral capsules/tablets
Intravenous solutions*
Transdermal patches*
Ointments
Translingual sprays*
*Bypass the liver and the first-pass effect
Mechanism of Action and Drug Effects
Cause vasodilation because of relaxation of smooth muscles
Potent dilating effect on coronary arteries
Result: oxygen to ischemic myocardial tissue
Used for prevention and treatment of angina
Rapid-acting forms
Used to treat acute anginal attacks
Sublingual tablets or spray; IV infusion Long-acting
forms
Used to prevent anginal episodes
nitroglycerin (both rapid and long acting)
isosorbide dinitrate (both rapid and long acting)
isosorbide mononitrate (primarily long acting)
A patient with extremely high blood pressure (BP) is in the emergency department. The
health care provider will order therapy with nitroglycerin to manage the patient’s blood
pressure. Which form of nitroglycerin is most appropriate?
A. Sublingual spray
B. Transdermal patch
C. Oral capsule
D. Intravenous infusion
Correct answer: D
Rationale: The IV infusion of nitroglycerin will have the fastest effect, and the dose will
be titrated to the patient’s response.
Nitrates
,Antianginal Drugs
,Angina Pectoris (chest pain)
When the supply of oxygen and nutrients in the blood is insufficient to meet the
demands of the heart, the heart muscle “aches.”
The heart requires a large supply of oxygen to meet the demands placed on it.
Ischemia
Ischemia
Poor blood supply to an organ
Ischemic heart disease
Poor blood supply to the heart muscle
Atherosclerosis
Coronary artery disease
Myocardial infarction
Necrosis, or death, of cardiac tissue
Disabling or fatal
Type of angina
Chronic stable angina (also called classic or effort angina)
Unstable angina (also called preinfarction angina)
Vasospastic angina (also called Prinzmetal or variant angina)
Goal of medical management
• Minimize the frequency, decrease the durations and intensity of angina attacks
• Improve functional capacity with few adverse effects
• Prevent or delay MI
A person who is mowing the lawn on a hot Saturday afternoon begins to notice chest
pain. What should this person’s first action be? A. Take a nitroglycerin tablet.
B. Stop mowing and sit or lie down.
C. Go inside the house to cool off and get a drink of water.
D. Call 911.
Correct answer: B
Rationale: At the first sign of chest pain, the person should stop all activity and sit or lie
down before taking the nitroglycerin tablet.
Drugs for Angina
Nitrates and nitrites ß-
Blockers
, Calcium channel blockers
Nitrates and Nitrites
Available forms
Sublingual*
Chewable tablets
Oral capsules/tablets
Intravenous solutions*
Transdermal patches*
Ointments
Translingual sprays*
*Bypass the liver and the first-pass effect
Mechanism of Action and Drug Effects
Cause vasodilation because of relaxation of smooth muscles
Potent dilating effect on coronary arteries
Result: oxygen to ischemic myocardial tissue
Used for prevention and treatment of angina
Rapid-acting forms
Used to treat acute anginal attacks
Sublingual tablets or spray; IV infusion Long-acting
forms
Used to prevent anginal episodes
nitroglycerin (both rapid and long acting)
isosorbide dinitrate (both rapid and long acting)
isosorbide mononitrate (primarily long acting)
A patient with extremely high blood pressure (BP) is in the emergency department. The
health care provider will order therapy with nitroglycerin to manage the patient’s blood
pressure. Which form of nitroglycerin is most appropriate?
A. Sublingual spray
B. Transdermal patch
C. Oral capsule
D. Intravenous infusion
Correct answer: D
Rationale: The IV infusion of nitroglycerin will have the fastest effect, and the dose will
be titrated to the patient’s response.
Nitrates
