Drugs used in angina

ung acling nitrates are more stable and may be effective for several hour, depending on the drug and pieparaiion used (sublingual, oral, oral sustained release). Isosorbide dinilrale is widely used, but it is rapidly metabolized by the liver. The use of tsufiiiiiiide mononitrate. which is the main active metabolite rtf the dinitraie. avoids the variable absorption and unpiedictable first-pass metabolism of the dinitraie. 

Many antiarrhythmic drugs have local anaesihciic activity (i.c, block voliagc-dependetu Na channels) or are calcium aniagonisLs. These actions decrease the automaticity of pacemaker cells and increase the effective refrticlory jxrritxl of atrial, ventricular and Purkinje fibres. 

1 those which are effective in supraventricular arrhythmias (top right)  

2 those effective in ventricular arrhythmias (bottom left) and 

3 those effective in bnlh types (middle lefl). 

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Angina can be viewed as a problem of supply and demand. Drugs used in angina pectoris are those that either increase supply of oxygen and nutrients, or reduce the demand for these — or both. 

TPR via arteriolar dilation—mechanism likely to involve the NO/EDRF pathway (see schematics in section on drugs used in angina). 

Coronary vasodiiator Older incorrect name for drugs useful in angina. Drugs that relieve angina of effort do not act primarily through coronary vasodilation some potent coronary vasodilators are ineffective in angina... 

Table 12-2. Pharmacokinetically distinct forms of nitrate and nitrite drugs used in angina.

Q25 Drugs used in the treatment of prophylaxis of angina include all EXCEPT ... 

While Lind described the method of the comparative trial, he was not concerned with issues that we now call the placebo effect. The first placebo controlled trial was published by Evans and Hoyle in 1933. They evaluated drugs used in the treatment of angina pectoris. Their comments almost 75 years ago are appropriate today. 

Evans W, Hoyle C. The comparative value of drugs used in the continuons treatment of angina pectoris. Q J Med 1933 28 311-38. 

The drugs used in the treatment of angina pectoris are classified as in table 4.3.1. 

Chapter 12 Vasodilators the Treatment of Angina Pectoris Chapter 13 Drugs Used in Heart Failure Chapter 14 Agents Used in Cardiac Arrhythmias Chapter 15 Diuretic Agents... 

Table 12-3 Nitrate and Nitrite Drugs Used in the Treatment of Angina. ...

Table 12-6 Drugs or Drug Groups under Investigation for Use in Angina.

All three of the drug groups currently approved for use in angina (organic nitrates, calcium channel blockers, and 3-blockers) decrease myocardial oxygen requirement by decreasing the determinants of oxygen demand (heart rate, ventricular volume, blood pressure, and contractility). In some... 

Aspirin decreases the incidence of transient ischemic attacks, unstable angina, coronary artery thrombosis with myocardial infarction, and thrombosis after coronary artery bypass grafting (see Chapter 34 Drugs Used in Disorders of Coagulation). 

Membrane bioreactors have been reported for the production of diltiazem chiral intermediate with a multiphase/extractive enzyme membrane reactor [15, 16]. The reaction was carried out in a two-separate phase reactor. Here, the membrane had the double role of confining the enzyme and keeping the two phases in contact while maintaining them in two different compartments. This is the case of the multiphase/ extractive membrane reactor developed on a productive scale for the production of a chiral intermediate of diltiazem ((2R,3S)-methylmethoxyphenylglycidate), a drug used in the treatment of hypertension and angina [15]. The principle is illustrated in... 

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. ... 

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