Angina pectoris

1. Classify antianginal drugs. Describe the pharmacology, uses and adverse effects of
nitrates (2015)
2. Classify drugs for angina pectoris. Describe pharmacology of nitrates in
management of angina (Jan, 2013)
3. Classify drugs for angina pectoris. Describe mechanism of action,, pharmacological
effects, uses and adverse effects of nitrates (2012)
4. Write short note on nitrates(aug, 2013, Jan 2011)
5. Write short note on drugs used in classical angina(2011)




Definition
Angina pectoris is a primary symptom of myocardial ischemia, which is the severe chest
pain that occurs when coronary blood flow is inadequate to supply the oxygen required by
the heart.
Symptoms
Heavy strangulation or pressure-like sensation, sometimes may feel like indigestion, usually
located in retrosternal area , often radiating to the left shoulder, left arm, jaw, neck, epigastrium
or back.
Classifications of angina
 Stable angina pectoris
 Unstable angina pectoris
 Prinzmetal’s /Variant angina pectoris

Stable angina
 Is caused by narrowed arteries due to atherosclerosis
 Occurs when there is exertion /effort
 Episodes of pain tend to be alike
 Usually lasts a short time
 Is relieved by rest or antianginals
Prinzmental’s angina
 Usually occurs at rest
 Tend to be severe
 Is caused by a transient spasm in a coronary artery
 Is relieved by anti-anginal drugs
Unstable angina
 Often occurs at rest
 Is more severe and lasts longer than stable angina

, Etiology (cause of ischemia)
 Either oxygen demand or ¯ oxygen supply
 Inadequate blood supply and decreased oxygen supply are directly related to blockade or
narrowed vessels


Classification of anti-anginal drugs

1. NITRATES

2. BETA BLOCKERS (Example: Propranolol, metoprolol, atenolol)

3. CALCIUM ANTAGONISTS (Example: Nifedipine, amlodipine, verapamil)

4. POTASSIUM CHANEL ACTIVATORS (Example: Nicorandil, Minoxidil)



Treatment of angina
 Relief of symptoms

 Slowing progression of the disease

 Reduction of future events like myocardial infarction

 Drugs:

1. For treatment of acute attacks:

 Organic nitrates/nitrites

2. For prophylaxis:

 Organic nitrates

 Beta blockers

 Calcium channel blockers

 K+ channel opener- Nicorandil
 Ranolazine