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drug treatment of ischemic heart disease

Ischemic heart disease Angina pectoris. Stable angina Unstable angina Variant angina (Prinzmetal) . ORGANIC NITRATES BETA ADRENERGIC RECEPTOR BLOCKERS CALCIUM CHANNEL BLOCKERS POTASSIUM CHANNEL OPENER Other drugs include Dipyrimadole, Trimetazidine, and ivabradine. . ANTIANGINAL DRUGS.

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drug treatment of ischemic heart disease

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    1. Dr Aneela Khalid Drug treatment of Ischemic heart disease

    5. Classification of Beta blocking drugs 1-According to selectivity A Non selective (b1, b2) blockers 1.Pure blockers Sotalol Timolol Nadolol 2.With membrane stabilizing activity (msa) Propranolol Pindolol

    6. 3.With intrinsic sympathetic activity (Isa) Pindolol Carteolol 4.With intrinsic sympathetic activity (Isa) & membrane stabilizing activity Oxprenolol Alprenolol

    7. B) Cardioselective (b1) blockeres 1. Pure blockers Atenolol Bisoprolol Esmolol 2. With membrane stabilizing activity Metoprolol Tolamolol 3.With intrinsic sympathetic activity Practolol Celiprolol

    8. 4. With isa & msa Acebutalol 5-Both ? & ? blockers labetalol Carvedilol Bucindolol

    9. 2- According to solubility Lipid soluble Propanolol Timolol Metoprolol Penbutalol Water soluble Acebutalol Nadolol Atenolol

    10. 3-According to duration of action 1 Short acting drugs Esmolol 2 Intermediate acting drugs Propranalol Pindolol Timolol Metoprolol 3 Long acting drugs Nadolol Atenolol Bisoprolol

    12. Role of Beta blockers in treatment of ischemic heart disease Pharamcological actions of Beta blockers on heart. Negative chronotropic effect ( heart rate) Negative ionotropic effect ( force of contraction) Decrease velocity of conduction in the atria and AV node.

    13. Decrease spontaneous rate of depolarization of ectopic pacemaker. Decrease cardiac output (stroke vol H/R) All of these effects decreases work load on heart and consequently decreases oxygen requirement of myocardium.

    14. In case of decreased stimulation of beta receptors this effect is modest while at the time of sympathetic activation, beta blockers attenuate the expected rise in heart rate. In case of short term administration of beta blockers as cardiac output decreases, peripheral resistance increases to maintain the blood pressure.

    15. While in long term use of beta blockers total peripheral resistance returns to initial values or decreases in patients with hypertension (blockade of ß1 receptor). All beta blockers are equally effective in decreasing frequency and severity of attacks and increasing exercise tolerance in classical angina.

    16. Long term beta-blocker use decreases the incidence of sudden cardiac death among patients with angina pectoris Beta blockers should not be used alone in unstable angina because of worsening of coronary vasospasm if present (unopposed a receptor mediated constriction of coronary vessel)

    17. Beta blockers are not useful in patients with variant angina and in patients with associated diseases like diabetes mellitus, hyperlipadaemic states, bronchial asthma, pheripherial vascular spastic diseases.

    18. On Heart Blockade of voltage gated calcium channels ? Reduced Ca++ influx into cardiac cells ? No breaking of troponin bridge ? Less contraction ? Less O2 consumption

    19. On Heart Blockade of voltage gated calcium channels ? Reduced Ca++ influx into cardiac cells ? No breaking of troponin bridge ? Less contraction ? Less O2 consumption

    20. Role of calcium channel blockers in ischemic heart disease. Calcium channel blockers reduces the impulse generation in SA node and impulse conduction in AV node. CCB reduces cardiac contractility in a dose dependant manner as the excitation contraction coupling in all cardiac cells require calcium influx.

    21. On Heart Blockade of voltage gated calcium channels ? Reduced Ca++ influx into cardiac cells ? No breaking of troponin bridge ? Less contraction ? Less O2 consumption

    22. This reduction in cardiac mechanical functions reduces the oxygen requirement of patient in angina. Cardiac sodium channel blockade is modest with Verapamil, less marked with diltiazem and negligible with other dihydropyridines. Verapamil and diltiazem block tachycardia in calcium dependent cells. e.g. AV node more selectively then dihydropyridines.

    23. Calcium channel blockers are effective in increasing time to onset of angina and ST depression during treadmill test in patient with angina of effort. CCB are effective For maintenance of chronic stable angina Along with nitrates, CCB are effective for relieving and preventing ischemic episodes in patients with variant angina

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