IVMS-CV Pharmacology -Anti-Aniginal Agents

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IVMS-CV Pharmacology -Anti-Aniginal Agents

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CV PharmacologyAnti-Anginal Agents : CV PharmacologyAnti-Anginal Agents Prepared and Presented: Marc Imhotep Cray, M.D. Professor Medical Pharmacology and Therapeutics Recommended Reading: Antianginal Drugs Formative Assessment Practice question Clinical: E-Medicine Article Angina Pectoris Coronary Artery Disease

Coronary heart disease (CHD) Defined (Etiologic Dx) : 2 Coronary heart disease (CHD) Defined (Etiologic Dx) Coronary heart disease (CHD) is a condition in which proper circulation of blood and oxygen are not provided to heart and surrounding tissue. Result is due to a narrowing of small blood vessels, which normally supply heart with blood and oxygen. Coronary heart disease, a type of cardiovascular disease, is the leading cause of death for both men and women in the United States. IVMS©2010

Causes (Anatomic Dx) : 3 Causes (Anatomic Dx) The typical cause of coronary heart disease is atherosclerosis, which takes place with plaque and fatty build up on the artery walls, narrowing the vessels. http://en.wikipedia.org/wiki/Atherosclerosis IVMS©2010

CAD Risk Factors : 5 CAD Risk Factors Certain conditions are considered to put an individual at greater risk for coronary heart disease. The following are some risk factors: Age (particularly 40+) Diabetes Genetics (heredity) High blood pressure High bad cholesterol (LDL) Increased levels of C-reactive protein, fibrinogen, or homocysteine Lack of sufficient physical activity Low good cholesterol (HDL) Menopause Obesity Smoking IVMS©2010

Diagnosis : 7 Diagnosis Diagnosis of coronary heart disease may be accomplished by a variety of means: Coronary angiography Coronary arteriography Coronary CT angiography Echocardiogram Electrocardiogram (ECG) Electron-beam CT (EBCT) Exercise stress test Magnetic resonance angiography Nuclear scan IVMS©2010

Treatment : 8 Treatment Coronary heart disease treatment methods may include: (depends on the presenting Physiologic Dx) Angioplasty with stenting Coronary artery bypass surgery Medication Minimally invasive heart surgery Proper diet and exercise Quitting smoking IVMS©2010

Angina Pectoris (Chest Pain) : 10 Angina Pectoris (Chest Pain) When the supply of oxygen and nutrients in the blood is insufficient to meet the demands of the heart, the heart muscle aches The heart demands a large supply of oxygen to meet the demands placed on it The myocardial supply:demand ratio--a critical review. [Am J Cardiol. 1978] IVMS©2010

R/O MI Algorithm : 11 R/O MI Algorithm Contemporary Diagnosis and Management of Unstable Angina GUYS. REEDER, MD From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn. http://www.mayoclinicproceedings.com/inside.asp?AID=1529&UID= IVMS©2010

Types of Angina : 13 Types of Angina Chronic stable angina (also called classic or effort angina) Unstable angina(also called preinfarction or crescendo angina) Vasospastic angina(also called Prinzmetal’s or variant angina) IVMS©2010

Antianginal Agents: : 15 Antianginal Agents: Therapeutic Objectives Minimize the frequency of attacks and decrease the duration and intensity of anginal pain Improve the patient’s functional capacity with as few side effects as possible Prevent or delay the worst possible outcome, MI IVMS©2010

Antianginal Agents: 1)Nitrates : 16 Antianginal Agents: 1)Nitrates Available forms: Sublingual Ointments Buccal Transdermal patches Chewable tablets Inhalable sprays Capsules Intravenous solutions IVMS©2010

Antianginal Agents:Nitrates(2) : 17 Antianginal Agents:Nitrates(2) Cause vasodilation due to relaxation of smooth muscles Potent dilating effect on coronary arteries Used for prophylaxis and treatment of angina IVMS©2010

Antianginal Agents: Nitrates(3) : 18 Antianginal Agents: Nitrates(3) Nitroglycerin Prototypical nitrate Large first-pass effect with PO forms Used for symptomatic treatment of ischemic heart conditions (angina) IV form used for BP control in perioperative hypertension, treatment of CHF, ischemic pain, and pulmonary edema associated with acute MI IVMS©2010

Antianginal Agents:Nitrates(4) : 19 Antianginal Agents:Nitrates(4) isosorbide dinitrate (Isordil, Sorbitrate, Dilatrate SR) isosorbide mononitrate (Imdur, Monoket, ISMO) Used for: Acute relief of angina Prophylaxis in situations that may provoke angina Long-term prophylaxis of angina IVMS©2010

Antianginal Agents:Nitrates(5) : 20 Antianginal Agents:Nitrates(5) Side Effects Headache Usually diminish in intensity and frequency with continued use Tachycardia, postural hypotension Tolerance may develop IVMS©2010

Antianginal Agents: Beta Blockers(2) : 22 Antianginal Agents: Beta Blockers(2) Mechanism of Action Decrease the HR, resulting in decreased myocardial oxygen demand and increased oxygen delivery to the heart Decrease myocardial contractility, helping to conserve energy or decrease demand IVMS©2010

Antianginal Agents: Beta Blockers(4) : 24 Antianginal Agents: Beta Blockers(4) Side Effects Body System Effects Cardiovascular bradycardia, hypotension second- or third-degree heart block heart failure Metabolic Altered glucose and lipid metabolism IVMS©2010

Antianginal Agents: Beta Blockers(5) : 25 Antianginal Agents: Beta Blockers(5) Side Effects Body System Effects CNS dizziness, fatigue, mental depression, lethargy, drowsiness, unusual dreams Other impotence wheezing, dyspnea IVMS©2010

Antianginal Agents: Calcium Channel Blockers(2) : 27 Antianginal Agents: Calcium Channel Blockers(2) Mechanism of Action Cause peripheral arterial vasodilation Reduce myocardial contractility (negative inotropic action) Result: decreased myocardial oxygen demand IVMS©2010

Antianginal Agents: Calcium Channel Blockers(2) : 28 Antianginal Agents: Calcium Channel Blockers(2) Therapeutic Uses First-line agents for treatment of angina, hypertension, and supraventricular tachycardia Short-term management of atrial fibrillation and flutter Several other uses IVMS©2010

Antianginal Agents: Calcium Channel Blockers(3) : 29 Antianginal Agents: Calcium Channel Blockers(3) Side Effects Very acceptable side effect and safety profile May cause hypotension, palpitations, tachycardia or bradycardia, constipation, nausea, dyspnea IVMS©2010

Cardiovascular Animations and Interactive Tutorials : 30 Cardiovascular Animations and Interactive Tutorials Cardiovascular System Topics by ADAM Basic Heart Circulation Bristol-Myers Squibb Heart Structure by Nucleus Communications Heart functions and Problems Cardiology Associates Electrocardiogram -ECG Technician Nobel eMuseum Hyper heart by Knowlege Weavers The Arrhythma Center HeartCenterOnline Cardiac Cell Death San Diego State University Prenatal Heart HeartCenterOnline Congenital Heart Disease HeartCenterOnline IVMS©2010

Cardiovascular Animations and Interactive Tutorials(2) : 31 Cardiovascular Animations and Interactive Tutorials(2) Valvular Functions and Diseases HeartCenterOnline Electro Cardio Gram by Knowlege Weavers Mammal Fetal Circulation by HHMI Cardiology - Visible Heart by HHMI The Electrocardiogram Basics McGill University Heart Animations Science Museum of Minnesota Operation Heart Transplant from PBS Interpeting an EKG EKG Tutorial RnCeus Interactive Blaufuss Medical Multimedia Heart Valves Movie by Marcy Thomas at Wellesley Aninations of Common Heart Defects and RepairMiami Children's Hospital Cadaver Dissection of the Human Heart Virtual Autopsy HBO IVMS©2010

Free Useful Plugins : 32 Free Useful Plugins Adobe Acrobat Reader - Document Distribution Adobe Flash Player - Web Animation -The leading rich client for Internet content and applications across the broadest range of platforms. Adobe Shockwave Player - With Adobe Shockwave Player, you can enjoy multimedia games and learning applications, using exciting new 3D technology. Adobe Authorware Player - With Adobe Authorware Web Player, you can experience online learning applications on the Web . QuickTime Player- Streaming/Multimedia IVMS©2010

Free Useful Plugins : 33 Free Useful Plugins RealOne Player - Streaming/Multimedia Microsoft Windows Media Player - Streaming/Multimedia Microsoft Word Viewer - Viewing Word documents online (required if Word is not installed on resident computer; PC only) Microsoft PowerPoint Viewer - Viewing PowerPoint presentations online (required if PowerPoint is not installed on computer) Animated PowerPoint Add-in -needed if you do not have Office XP Microsoft Excel Viewer - Viewing Excel documents online (required if Excel is not installed on resident computer; PC only) MDL Chime interactively displays 2D and 3D molecules directly in Web pages. IVMS©2010