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Share Angina
Share Angina
Share Angina
Types of angina
• Classical/stable/predic • Vasospastic/ • Crescendo/Acute
table coronary
Prinzmetal’s angina syndrome
• Occurs upon exertion, • Unpredictable, • Increased
emotional stress; occurs at frequency and
• relieved by rest rest/sleep severity
(demand decreases • Due to vasospasm • Due to unstable
and becomes equal to of coronary artery plaque that
supply) ruptures leading
• Atherosclerosis is the to platelet
main cause aggregation and
thrombus
• 90% of angina cases formation
Antianginals
1. Nitrates
• Short acting (GTN) Glyceryl trinitrate or Nitroglycerine
• Long acting: Isosorbide dinitrate (short acting by
sublingual route), isosorbide mononitrate, Erythrityl
tetranitrate, Pentaerythritol tetranitrate
2. β blockers
• Non selective: Propranolol
• Cardioselective: Atenolol, Metoprolol
3. Potassium channel openers:
• Nicorandil
Classification
4. Calcium channel blockers:
Phenyl alkylamine: Verapamil
Benzothiazepines: Diltiazem
Dihydropyridines: Nifedipine, Felodipine,
Amlodipine, Nitrendipine etc.
5. Others: Dipyridamole, Oxyphedrine,
Trimetazidine, Ranolazine, Ivabradine
Clinical classification
• Used to abort or terminate attack: GTN,
Isosorbide dinitrate (sublingually)
• Used for chronic prophylaxis: All other drugs
Nitrates
• ADRs: Throbbing headache, palpitation, dizziness and
fainting.
• Tolerance: Cross tolerance occurs among all nitrates.
The most practical way to prevent nitrate tolerance
is to provide nitrate free intervals everyday.
• Dependence: Sudden withdrawal after prolonged
exposure has resulted in spasm of coronary and
peripheral blood vessels. MI and sudden deaths have
been recorded.
Interactions
• Sildenafil causes dangerous potentiation of
nitrate action: severe hypotension, MI and
deaths are on record.
Haemoglobin
| Sod. nitrite (10 ml of 3% solution i.v.)
Methaemoglobin
| Cyanide
Cyanomethaemoglobin
| Sod. thiosulfate (50 ml of 25% solution i.v.)
Methaemoglobin + Sod. thiocyanate
↓
Excreted in urine
GTN
• Transdermal patches
• Oral presystemic metabolism: 90%
• Large doses are given orally to counter
hepatic metabolism
• SR tablets for chronic prophylaxis
• IV infusion to manage unstable angina
Nitrates: Isosorbide dinitrate
• Sublingual (at the time of attack) or oral
(prophylaxis)