Antianginal Drugs Pharmacology Flash Cards

Antianginal Drugs Pharmacology Flash Cards

Antianginal drugs are a class of medications used to treat angina pectoris, a type of chest pain caused by reduced blood flow to the heart. These drugs work by improving the balance between myocardial oxygen supply and demand. Here's a comprehensive overview of antianginal drugs, their mechanisms of action, and key points to remember:

Nitrates:

Examples: nitroglycerin, isosorbide dinitrate, isosorbide mononitrate

Mechanism: Release nitric oxide, causing vasodilation of veins and coronary arteries

Effects: Reduce preload and afterload, increase coronary blood flow

Uses: Acute angina relief, prophylaxis of angina attacks

Side effects: Headache, hypotension, tolerance with continuous use

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Beta-blockers:

Examples: metoprolol, atenolol, propranolol

Mechanism: Block beta-adrenergic receptors, reducing heart rate and contractility

Effects: Decrease myocardial oxygen demand, increase exercise tolerance

Uses: Long-term angina management, hypertension, post-MI

Side effects: Fatigue, bradycardia, bronchospasm (in susceptible patients)

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Calcium Channel Blockers (CCBs):

Examples: amlodipine, nifedipine, diltiazem, verapamil

Mechanism: Block calcium influx into smooth muscle and cardiac cells

Effects: Vasodilation, reduced heart rate and contractility (some agents)

Uses: Angina prophylaxis, hypertension, arrhythmias (some agents)

Side effects: Peripheral edema, constipation, headache

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Ranolazine:

Mechanism: Inhibits late sodium current in cardiac cells

Effects: Reduces intracellular calcium overload, improves diastolic relaxation

Uses: Chronic angina, add-on therapy

Side effects: Dizziness, headache, constipation

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Ivabradine:

Mechanism: Selective inhibitor of the If current in the sinoatrial node

Effects: Reduces heart rate without affecting contractility or blood pressure

Uses: Chronic stable angina in patients with normal sinus rhythm

Side effects: Visual disturbances, bradycardia

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Trimetazidine:

Mechanism: Metabolic modulator, shifts cardiac metabolism from fatty acid to glucose oxidation

Effects: Improves myocardial efficiency, reduces oxygen demand

Uses: Add-on therapy for chronic stable angina

Side effects: Gastrointestinal disturbances, rare cases of parkinsonism

Key points to remember:

Nitrates are the first-line treatment for acute angina attacks

Beta-blockers and CCBs are commonly used for long-term angina management

Combination therapy may be necessary for optimal symptom control

Consider underlying causes (e.g., coronary artery disease) and address risk factors

Monitor for side effects and adjust therapy as needed

Some antianginal drugs have additional indications (e.g., hypertension, arrhythmias)

Educate patients on proper medication use, especially for sublingual nitroglycerin

Encourage lifestyle modifications (e.g., smoking cessation, exercise) alongside pharmacotherapy

Be aware of potential drug interactions, especially with medications that affect heart rate or blood pressure

Regular follow-up is essential to assess treatment efficacy and adjust therapy if necessary

Understanding the pharmacology of antianginal drugs is crucial for healthcare professionals to provide optimal care for patients with angina pectoris. Each class of medication offers unique benefits and potential side effects, allowing for tailored treatment approaches based on individual patient needs and comorbidities.