1. Antianginal drugs Antidysrrhytmic drugs
Anton Kohút
P.J. Šafárik University
Faculty of Medicine
Department of Pharmacology
Košice
Ladies and gentlemen,
I would like to present, in couple of minutes, our preliminary results of recent project .
Impact……

2. DRUGS INFLUENCING THE HEART
a. Blod flow (supply by O2)
1. Antianginal drugs
b. Rhytm and rate
2. Antidysrhytmic drugs
c. Contraction (used to treat cardiac failure)
3. Cardiotonics

4. Antianginal drugs

5. Angina pectoris

7. Angina pectoris occurs when where is an imbalance between the oxygen suply and oxygen demands.

9. Cellular changes after ischemia

10. Causes of O2 imbalance Supply decreased by : Coronary artery disease
Decrease of vessel calibre
Compression of intramyocardial vessels
Anaemia
Demands are increased by:
 Exercise
 Tachycardia
 Hypertension (increased
preripheral resistance - afterload)
 Filling pressure ) preload)

12. Therapeutic strategy To increase supply To reduce demands
Dilatation of the coronary artery
Decrease of ventricular wall tension
To reduce demands
Decrease of myocardial contraction
Decrease of heart rate
 Decrease of preload
 Decrease of afterload

13. Vasodilators (dilate arteries and veins) -  calcium-channel blockers - nitrodilators
Cardioinhibitory drugs (reduce heart rate and contractility) -  beta blockers -  calcium-channel blockers
Ranolizine (blocker of late sodium currents)
Trimezatidine
Anti-thrombotic drugs (prevent thrombus formation) -  anticoagulants -  anti-platelet drugs

14. Antianginal drugs

15. Nitrates and nitrites

16. Mechanism of action of nitrates

17. Organic nitrates History - Nitroglycerin was first synthesized in 1846
- Hering, in 1847, developed the sublingual dosage form.
Chemistry
- Organic nitrates - esters of nitric acid,
- Organic nitrites - esters of nitrous acid
are capable of denitration to release nitric oxide (NO)
Effects
- Relaxation most of smooth muscle
- Dilatation of the veins predominates over that of arterioles
- Decrease of preload
- Systemic arterial pressure may fall slightly, and heart rate is unchanged or slightly increased reflexly.
Other Effects
The nitrovasodilators act on almost all smooth muscle.

18. Beta antagonists

19. Beta antagonists and cardiac rhytm

20. Classification of beta blockers

21. Calcium-channel blockers

22. Actions
Therapeutic uses
Hypertension
Angina pectoris
Cardiac failure
Dysrhytmias

23. Grops of calcium channels blockers

24. Therapeutic uses of calcium channel blockers
 angina pectoris (verapamil, diltiazem),
 cardiac failure (verapamil, diltiazem, amlodipine, nisoldipine),
 dysrrythmias (verapamil, diltiazem),
 hypertensions (dihydropyridines),
 migraine (verapamil),
 stroke (nimodipine).
Side effects
- tachykardia (nifedipine)
- ortostatic hypotension

25. Ranolazine Ranolazine represents a new class of antianginal drugs.
By blocking late inward sodium currents, calcium overload and diastolic wall stress are reduced, leading to improved coronary blood flow.
Partial fatty oxidation inhibitor
This agent is likely to become standard therapy for chronic stable angina and may play a future role in the management of acute coronary syndromes.

29. Antidysrhytmic drugs

31. Therapeutic indications of antiarrhythmic agents