Antianginal Drugs Garrett J. Gross

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Antianginal DrugsGarrett J. Gross
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Myocardial Preconditioning

• Single or multiple brief periods of ischemia
  result in a marked reduction in infarct size when
  the hearts are exposed to a more prolonged period
  of ischemia.
• Has 2 phasesAcute and Delayed PC
• Acute phase lasts 1-2 Hours
• Delayed phase lasts 24-72 Hours
• Nitrogycerin(GTN) produces delayed PC in animal
  and clinical studies.
• This effect persists even in the presence of
  tolerance to its vasodilator effects

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NITRATESTOLERANCE
" Decrease in the effect of a drug when
administered in a long-acting form"
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NITRATES CONTRAINDICATIONS
Previous hypersensitivity Hypotension ( lt 80
mmHg) AMI with low ventricular filling pressure
1st trimester of pregnancy
WITH CAUTION

• Constrictive pericarditis
• Intracranial hypertension
• Hypertrophic cardiomyopathy

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ß-ADRENERGIC BLOCKERS CONTRAINDICATIONS
Hypotension BP lt 100 mmHg Bradycardia HR lt 50
bpm Chronic bronchitis, ASTHMA Severe chronic
renal insufficiency
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Reasons for Using Nitrates and Beta Blockers in
Combination in Angina

• Beta Blockers prevent reflex tachycardia and
  contractility produced by nitrate-induced
  hypotension.
• Nitrates prevent any coronary vasospasm produced
  by Beta Blockers.
• Nitrates prevent increases in left ventricular
  filling pressure or preload resulting from the
  negative inotropic effects produced by Beta
  Blockers.
• Nitrates and Beta Blockers both reduce myocardial
  oxygen consumption by different mechanisms.
• Nitrates and Beta Blockers both increase
  subendocardial blood flow by different mechanisms

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