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MEDPHARM DRUGS FOR ISCHEMIC HEART DISEASE

FEBRUARY 10,2110. MEDPHARM DRUGS FOR ISCHEMIC HEART DISEASE. VIGNETTE. A 47 yr old man reports a 6 month Hx of chest pressure while playing handball.He describes substernal tightness and left arm numbness only while exerting.The total cholesterol and LDL are elevated. The

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MEDPHARM DRUGS FOR ISCHEMIC HEART DISEASE

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  1. FEBRUARY 10,2110 MEDPHARM DRUGS FOR ISCHEMIC HEART DISEASE

  2. VIGNETTE A 47 yr old man reports a 6 month Hx of chest pressure while playing handball.He describes substernal tightness and left arm numbness only while exerting.The total cholesterol and LDL are elevated. The exercise test is positive.How should the patient’s case be managed?

  3. Typical Progression of Coronary Atherosclerosis Abrams, J. N Engl J Med 2005;352:2524-2533

  4. Symptoms of Angina Abrams J. N Engl J Med 2005;352:2524-2533

  5. Classification and Severity of Angina Abrams J. N Engl J Med 2005;352:2524-2533

  6. Lalplace Equation • Wall stress = Pr/w where: P = pressure r = radius w = wall thickness

  7. EFFECTS OF NITROGLYCERIN Marked venodilation with sublingual use Decreased ventricular preload Decreased ventricular size Decreased end-diastolic pressure NET EFFECT:Decreased oxygen demand Slight arteriolar dilation with higher doses

  8. Regulation of the Relaxation of Vascular Smooth Muscle by Nitric Oxide NITROGLYCERIN Griffiths, M. J.D. et al. N Engl J Med 2005;353:2683-2695

  9. NITROGLYCERIN USES: Angina pectoris-prophylaxis and treatment Heart failure SIDE EFFECTS: Tolerance Headache Syncope Interaction with sildenafil(Viagra &others)

  10. NITROGLYCERIN Direct relaxation of all vascular smooth muscle Venous relaxation with oral or topical use Arteriolar and venous relaxation with IV use

  11. ISOSORBIDE DINITRATE ACTION Venous relaxation – Long acting USES Oral Angina pectoris – prophylaxis Heart failure-when ACE inhibitors/ARBs contraindicated ADR Headache, Nitrate tolerance Interaction wiih sildenafil

  12. Regulation of the Relaxation of Vascular Smooth Muscle by Nitric Oxide NITROGLYCERIN Griffiths, M. J.D. et al. N Engl J Med 2005;353:2683-2695

  13. BETA- ADRENERGIC BLOCKERS Equally Effective for: Hypertension Angina Arrhythmias

  14. BETA BLOCKERS METOPROLOL PROPRANOLOL

  15. BETA-BLOCKERS for ANGINA • Limit heart rate • Decrease myocardial contractility • Decrease oxygen demand

  16. BETA BOCKERS – ADVERSE EFFECTS CNS Cardiovascular Bad dreams Aggravation of severe CHF Depression Aggravation of occlusive arterial disease Slow A-V conduction Pulmonary Bronchospasm in Asthmatics Drug interactions With drugs that impair A-V conduction (digoxin and some calcium channel blockers)

  17. CALCIUM CHANNEL ANTAGONISTS FOR ANGINA PECTORIS Verapamil Others Diltiazem Nifedipine

  18. CALCIUM CHANNEL BLOCKERS ON THE HEART

  19. PHARMACODYNAMICS OF CALCIUM CHANNEL BLOCKERS

  20. CALCIUM CHANNEL ANTAGONISTSMECHANISM OF ACTION IN ANGINA PECTORIS Decreased in myocardial oxygen demand Decrease in afterload Decrease in cardiac contractility ( V & D)* Increase in myocardial oxygen supply Increase in coronary blood flow * Verapamil & Diltiazem

  21. CALCIUM CHANNEL ANTAGONISTSADVERSE EFFECTS Hypotension Heart failure Headache AV Block Constipation Peripheral edema

  22. ANTIANGINAL DRUGSCOMPARATIVE PHARMACOLOGIC EFFECTS Nitrates Calcium Beta Channel Blockers Blockers Increase in O2 o + o Supply Decrease in O2 + + + Demand

  23. ANTIANGINAL DRUGSCOMPARATIVE ADVERSE EFFECTS Nitrates Calcium Beta Channel Blockers Blockers AV Block  + + LV Dysfunction  + -/+ Bronchoconstriction   +

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