Antianginal Drugs Overview

A condition where the coronary arteries narrow, restricting blood flow to the heart and causing chest pain.

A type of chest pain caused by reduced blood flow to the heart muscle, usually triggered by physical exertion.

Chest pain that is more severe and frequent, occurring at rest or with minimal exertion, and may be a sign of an impending heart attack.

Chest pain that occurs at rest due to spasms in the coronary arteries, often triggered by cold temperatures or stress.

The amount of blood that the heart needs to supply to the body during exertion.

The amount of blood that the heart can actually deliver through the coronary arteries.

The balance between the amount of blood the heart needs and the amount it can actually deliver.

Atherosclerosis causes a fixed obstruction in the coronary arteries, reducing blood flow, leading to ischemia and angina during exertion.

A condition characterized by sudden, severe chest pain caused by a complete or partial blockage of a coronary artery, often due to a ruptured plaque.

A group of drugs used to treat angina by balancing oxygen supply and demand.

Drugs that block the effects of adrenaline, reducing heart rate and force of contraction, lowering oxygen demand.

Beta-blockers are generally recommended for all patients except those with vasospastic angina.

Beta-blockers are not effective and can even worsen vasospastic angina.

Beta-blockers that also have a mild stimulating effect on the heart should be avoided.

Beta-blockers should not be used in individuals with a slow heart rate, as it could worsen their condition.

Nonselective beta-blockers should be avoided in patients with asthma due to their potential to trigger bronchospasm.

Calcium channel blockers (CCBs) work by blocking the entry of calcium into cardiac and smooth muscle cells, leading to vasodilation of coronary and peripheral arteries.

Dihydropyridine CCBs, like amlodipine and nifedipine, are effective for variant angina due to their potent vasodilation effect.

Short-acting dihydropyridines should be avoided in patients with coronary artery disease (CAD) because they may increase the risk of heart attack.

Verapamil, a nondihydropyridine CCB, directly slows conduction in the heart, leading to decreased heart rate, contractility, and blood pressure.

Diltiazem, a nondihydropyridine CCB, is useful for variant angina because it can relieve coronary artery spasms.

Organic nitrates, like nitroglycerin, are converted into nitric oxide, which leads to vasodilation and reduced myocardial oxygen demand.

Organic nitrates cause dilation of systemic arteries and veins, decreasing afterload and preload, and reducing oxygen demand by the heart.

Organic nitrates directly dilate coronary arteries, improving the supply of oxygen to the heart muscle.

Tolerance to nitrates develops rapidly as blood vessels become desensitized to vasodilation.

Nitrates are typically taken in the late afternoon/early evening to avoid tolerance.

Nitroglycerin acts quickly, within about 1 minute, while isosorbide mononitrate takes around 30 minutes to take effect.

Nitroglycerin is the drug of choice for rapid relief of angina because it has a fast onset of action. It's often taken sublingually or as a buccal spray.

Nitroglycerin undergoes extensive first-pass metabolism, meaning a significant portion is broken down before reaching the bloodstream. Therefore, it's often given sublingually or transdermally to bypass the liver.

Isosorbide mononitrate has improved bioavailability, meaning more of it reaches the bloodstream, due to less first-pass metabolism.