Cardiac drugs antianginals

Cardiac Agents Cardiac Glycosides, Antianginal, and Antiarrhythmic Drugs... 

Propranolol is a prototype of this series of drugs and is the oldest and most widely used nonselective )3-adrenoblocker. It possesses antianginal, hypotensive, and antiarrhythmic action. Propranolol is a cardiac depressant that acts on the mechanic and electrophysio-logical properties of the myocardium. It can block atrioventricular conductivity and potential automatism of sinus nodes as well as adrenergic stimulation caused by catecholamines nevertheless, it lowers myocardial contractility, heart rate, blood pressure, and the myocardial requirement of oxygen. 

In addition to being used as antianginal and antiarrhythmic agents, calcium channel blockers are used to treat weak and moderate hypertension. These drugs prevent calcium ions from entering into the smooth muscle cells of peripheral vessels, and they cause relaxation of peripheral vessels, which leads to lowering of arterial blood pressure. In clinically used doses, calcium channel blockers relax smooth musculature of arteries and have little effect on veins. In doses that relax smooth musculature, calcium channel blockers have relatively little effect on cardiac contractility. 

Nicorandil is an effective vasodilator through two actions. It acts as a nitrate by activating cyclic GMP (see above) but also opens the ATP-dependent potassium channel to allow potassium efflux and h5rperpolarisation of the membrane which reduces calcium ion entry and induces muscular relaxation. It is indicated for use in angina, where it has similar efficacy to p-blockade, nitrates or calcium channel blockade. It is administered orally and is an alternative to nitrates when tolerance to these is a problem, or to the other classes when these are contraindicated by asthma or cardiac failure. Adverse effects to nicorandil are similar to those of nitrates, with headache reported in 35% of patients. It is the only antianginal drug for which at least one trial has demonstrated a beneficial influence upon outcome. ... 

Cayl channels (L-type) are targets of calcium-channel blockers or calcium antagonists which decrease the influx of Ca + in cardiac and smooth muscle vascular cells dihy-dropyridines (nifedipine and analogs), phenylalkylamines (verapamil) and benzothiazepines (diltiazem), widely used as antihypertensive, antianginal and antiarrhythmic drugs. Cayl openers, like Bay K 8644, have been synthesized but have not found any therapeutic interest. 

Mirsky I, Ghista DN, Sandler H (1974) Cardiac Mechanics Physiological Clinical and Mathematical Considerations. New York John Wiley Sons Inc. p 45 Moir TW (1972) Subendocardial distribution of coronary blood flow and the effect of antianginal drugs. Circ Res 30 621-627... 

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