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ObjectivesName the main classes of Anti anginal and antihypertensive drugs
Describe the principles of drug action in the treatmentof Angina and HypertensionDescribe the mechanism of action of the above drugsName the adverse effects of each of the drugs
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Angina Pectoris
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Main anti anginal drug classesOrganic Nitrates
Beta blockers
Calcium Channel blockers
(Antiplatelet drugs)
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Angina PectorisDEMAND
SUPPLY
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Principals of drug Action in AnginaSUPPLY Dilates Coronaries
Slows Heart Rate
DEMAND Reduces Preload
Reduces AfterloadReduces contractility Slows heart rate
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The NitratesCause Vasodilatation
Dilates Venules >> Arterioles
Veno dilatation Preload O 2 Demand
Coronary dilatation ImprovesCoronary Flow
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Mechanism of actionReleases NO intracellulary Activates Guanylate cyclase
cyclic GMP
free intracellular Ca
vascular smooth muscle relaxation
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The NitratesOral / Sublingual / Transdermal / IV GTN Sublingual spray usually
Short half life- few minutesImmediate relief of angina
ISMN/ISDN TabletsLonger half lifeContinuous cover
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The NitratesNitrate Tolerance Nitrate free periodneeded
Adverse EffectsHeadache
HypotensionCollapse
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Calcium Channel blockers Vasodilators, arterioles >> venulesDepress myocardium, slow cardiac conduction
Varying selectivity to the above Arteriolar dilatation Afterload
cardiac conduction Heart ratecardiac contractility
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Mechanism of actionBlock L type voltage gated Calcium channels in
arterioles
Reduced Intracellular Calcium
Smooth muscle relaxationDepress cardiac pacemaker cells Negative inotropicand chronotropic action
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Calcium Channel blockersDihydropyridines Less effects on myocardium
nifedipine, amlodipine
Non- dihydropyridines More effects onmyocardium
verapamil, diltiazem
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Adverse effects of Ca ch. blockers Ankle oedemaFlushingHeadache
HypotensionPalpitations
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The Beta Adrenoreceptor blockersBlock cardiac 1adrenoreceptor Heart
rate
cardiac contractility cardiac O 2demand
Also reduces renin secretion from the kidney
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Adverse drug effects of Beta blockers
Bronchoconstriction Caution in asthmaCold extremities
FatigueBradycardiaHypoglycaemia
Precipitation of cardiacfailureBad dreams
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A bad dream..??
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Drugs used in Hypertension
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Factors affecting blood pressure
BLOOD = CARDIAC PERIPHERAL
PRESSURE OUTPUT RESISTANCE(vascular tone)
Heart Rate Stroke Volume
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Renin Angiotensin-Aldosterone
SystemLow renal bloof flowrenin
Angiotensinogen Angiotensin I ACE
Angiotensin I Angiotensin II
Angiotensin II is a powerful vasoconstrictor
Stimulates Aldosterone release Na retension
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ACE Inhibitors- mechanism
Inhibit synthesis of Angiotensin II
vascular resistance
Blood PressureReduced aldosterone
Na/H 2O retension Stroke Vol
BP
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ACE InhibitorsACE I s
captopril, ramipril, lisinoprilAngiotensin Receptor blockers
losartan, candesartan
Particularly useful in diabetic nephropathy
Adverse effects?? find out!
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