Exam (elaborations)
Angina pectoris
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A type of chest pain caused by reduced blood flow to the heart. Angina is a symptom of coronary artery disease.
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1. Classify antianginal drugs. Describe the pharmacology, uses and adverse effects ofnitrates (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
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