View
26
Download
0
Category
Tags:
Preview:
DESCRIPTION
DRUGS USED FOR ANGINA PECTORIS. LAKSHMAN KARALLIEDDE 2011. ANGINA PECTORIS SYMPTOM COMPLEX: CONSTITUTES A CLINICAL SYNDROME RATHER THAN A DISEASE CAUSE: TRANSIENT MYOCARDIAL ISCHAEMIA OCCURS WHEN EVER THERE IS AN INBALANCE BETWEEN MYOCARDIAL OXYGEN SUPPLY AND DEMAND - PowerPoint PPT Presentation
Citation preview
DRUGS USED FOR DRUGS USED FOR ANGINA PECTORISANGINA PECTORIS
LAKSHMAN KARALLIEDDE2011
ANGINA PECTORIS
SYMPTOM COMPLEX: CONSTITUTES A CLINICAL SYNDROME RATHER THAN A DISEASE
CAUSE: TRANSIENT MYOCARDIAL ISCHAEMIA
OCCURS WHEN EVER THERE IS AN INBALANCE BETWEEN MYOCARDIAL OXYGEN SUPPLY AND DEMAND
COMONEST CAUSE: ATHEROMATOUS DISEASE OF CORONARY ARTERIES
MAY ALSO BE A MANIFESTATION OF OTHER FORMS OF HEART DISEASE e.g. Severe aortic valve disease, hypertrophic cardiomyopathy
DRUGS USED TO RELIEVE OR PREVENT THE SYMPTOMS OF ANGINA
1. NITRATES2. BETA BLOCKERS3. CALCIUM ANTAGONISTS4. POTASSIUM CHANEL ACTIVATORS
AS THE FUNDAMENTAL CAUSE OF ANGINA PECTORIS IS INSUFFICIENT OXYGEN SUPPLY TO HEART MUSCLE, IT IS LOGICAL TO ATTEMPT TO INCREASE THE OXYGEN SUPPLY BY ADMINISTERING OXYGEN- THAT IS BY INCREASING THE INSPIRED OXYGEN CONCENTRATION SIMILARLY, PATIENTS WITH ANGINA MAY SUFFER FROM SEVERE PAIN AND PAIN RELIEF WITH A POTENT OPIATE
e.g. Morphine NEEDS TO BE CONSIDERED TO MAKE THE PATIENT MORE
COMFORTABLE, LESS ANXIOUS.
NITRATES
MODE OF ACTION : ACTS DIRECTLY ON VASCULAR SMOOTH MUSCLE TO PRODUCE ARTERIAL AND VENOUS DILATATION
EFFECT DURING ANGINA
1.REDUCES MYOCARDIAL OXYGEN DEMAND (LOWERS PRE-LOAD AND AFTER LOAD)2. INCREASES MYOCARDIAL OXYGEN SUPPLY (CORONARY VASODILATATION)
NITRATE PREPARATIONS
1.SUBLINGUAL GLYCERYL TRINITRATE (GTN)2.BUCCAL GLYCERYL TRINITRATE 3.TRANSDERMAL GLYCERYL TRINITRATE4.ORAL ISOSORBIDE DINITRATE5.ORAL ISOSORBIDE MONONITRATE6.INTRAVENOUS GTN- FOR ACUTE MYOCARDIAL INFARCTION/LEFT VENTRICULAR FAILURE -10 -200 µg /MIN INTRAVENOUS INFUSION, TITRATING TO CLINICAL RESPONSE AND BLOOD PRESSURE.
DURATION OF ACTION OF SOME NITRTATE PREPARATIONS
PEAK ACTIONDURATION OF
ACTION
Sublingual GTN(Tablet 300-500µg or metered dose aerosol 400µg/spray)
4-8 minutes 10-30 minutes
Buccal GTN (1-5 mg tablet 6 hourly)
4-10 minutes 30-300 minutes
Transdermal. GTN (5-10 daily)
1-3 hours Up to 24 hours
Oral isosorbidedinitrate.(10-20 mg 8 hourly)
45-120 hours 2-6 hours
Oral isosorbide mononitrate( 20-60 mg once or twice a day)
45-120 hours 6-10 hours
SUBLINGUAL GTN- Administered
a.as a tablet – 300-500 µg to disolve under the tongueb.As metered-dose aerosol (400 µg per spray)
RELIEVES AN ATTACK OF ANGINA IN 2-3 MINUTES
UNWANTED EFFECTS
HEADACHESYMPTOMATIC HYPOTENSION –DIZZINESS, POSTURAL GIDDINESS, BLURRING OF VISIONRARELY SYNCOPE – FAINTING
ASK PATIENT TO SPIT TABLET IF ABOVE EFFECTS OCCURNOT HABIT FORMINGTEACH PATIENTS TO USE PROPHYLACTICALLY e.g. Before exertingVIRTUALLY INEFFECTIVE IF SWALLOWED DUE TO EXTENSIVE FIRST PASS METABOLISM IN THE LIVER
CONTINUOUS USE CAUSES PHARMACOLOGICAL TOLERANCE THERFORE ATTEMPT TO INCLUDE A ‘NITRATE-FREE’ PERIOD OF 6-8 HOURS A DAY
CALCIUM ANTAGONISTSMODE OF ACTION1.DECREASES MYOCARDIAL OXYGEN DEMAND BY REDUCING BLOOD PRESSURE AND MYOCARDIAL CONTRACTILITY
TYPESA.DIHYDROPYRIDINE CALCIUM ANTAGONISTS-NIFEDIPINE, NICARDIPINE OFTEN CAUSE REFLEX TACHYCARDIA-BEST USED IN COMBINATION WITH BETA BLOCKER-not used or caution when usingB.VERAPAMIL AND DILITIAZEM-SUITABLE FOR PATIENTS WHO ARE NOT RECEIVING BETA BLOCKERS AS THEY DECREASE THE HEART RATE ( DANGEROUS ADDITIVE EFFECT)
CALCIUM CHANNEL ANTAGONISTS MAY REDUCE MYOCARDIAL CONTRACTILITY TO A DEGREE THAT CAN AGGRAVATEOR PRECIPITATE HEART FAILURE
UNWANTED EFFECTSPERIPHERAL OEDEMAFLUSHINGHEADACHEDIZZINESS
POTASSIUM CHANNEL ACTIVATORS
MODE OF ACTION: DILATES ARTERIES AND VEINS
DOES NOT EXHIBIT TOLERANCE SEEN WITH NITRATES
NICORANDIL- 10-30 mg 12 hourly
Caution in:hypovolaemic patientsPatients with pulmonary oedema
Side effects:a.Headacheb.Flushingc.Dizzinessd.Weaknesse.May cause a dose dependent increase in heart ratef.Myalgiag.Angioedema
ANTIPLATELET DRUGS
ASPIRINCLOPIDOGREL
THROMBOLYTIC AGENTSSTREPTOKINASEALTEPLASERETEPLASE-
ASPIRIN
ANTIPLATELE T EFFECT BY INHIBITION OF THROMBOXANE A 2NSAID, INHIBITS COX-1 AND COX -2 WHICH LEADS TO DECREASED PROSTAGLANDIN SYNTHESIS
USESTHROMBO-EMBOLIC CVA, ISCHAEMIC HEART DISEASE-PROPHYLAXIS (75MG/DAY) AND ACUTE TREAMENT (300 MG)
CONTRAINDICATIONS1.THOSE UNDER AGE OF 16Y-CAN INCREASE INCIDENCE OF REYE’S SYNDROME, LIVER/BRAIN DAMAGE2.GASTRO-INTESTINAL ULCERS3.BLEEDING DISORDERS4.GOUT5.HYPERSENSITIVITY TO ANY NSAID6.GFR <10ML/MIN
ASPIRINCAUTION1.ASTHMA2.UNCONTROLLED HYPERTENSION3.ANY ALLERGIC DISEASE4.G6PD DEFICIENCY5.DEHYDRATION
OTOTOXIC IN OVERDOSE
MAY INCREASE EFFECTS OF SULPHONYL UREAS AND OF METHOTREXATE
FOR ANALGESIA- 300-900 MG 4-6 HPOURLY –MAXIMUM DOSE4G/DAY
STOP 7 DAYS BEFORE SURGERY IF SIGNIFICANT BLEEDING IS EXPECTED
IF CARDIAC SURGERY OR PATIENT HAS ACUTE CORONARY SYNDROME- CONSIDER CONTINUING
CLOPIDOGREL
ANTIPLATELET AGENT- ADP RECEPTOR ANTAGONIST
USEPROPHYLAXIS OF ANTI-THROMBOTIC EVENTS IN NON—ST ELEVATIONMYOCARDIAL INFARCTION AND IN ST ELEVATION MYOCARDIAL INFARCTION-IN COMBINATION WITH ASPIRINMYOCARDIAL INFARCTION (WITHIN A ‘FEW’ TO35 DAYS)ISCHAEMICCEREBROVASCULAR ACCIDENT- WITHIN 7 DAYS TO 6 MONTHSPERIPHERAL ARTERIAL DISEASECONTRAINDICATIONACTIVE BLEEDING
NOT RECOMMENDED WITH WARFARIN
CLOPIDOGREL
SIDE EFFECTS
HAEMORRHAGE (ESPECIALLY GASTRO-INTESTINAL OR INTRA-CRANIAL GASTRO-INTESTINAL UPSET PEPTIC ULCER PANCREATITIS HEADACHE FATIGUE DIZZINESS PARAESTHESIA RASH/PRURITUS
MONITOR FULL BLOOD AND FOR SIGNS OF OCCULT BLEEDING
STREPTOKINASE
THROMBOLYTIC AGENTINCREASES PLASMINOGEN CONVERSION TO PLASMIN WHICH INCREASES FIBRIN BREAKDOWN
USES1.ACUTE MYOCARDIAL INFARCTION -1.5 MILLION UNITS INTRAVENOUS INFUSION OVER 60 MIN2.THROMBOEMBOLISM OF ARTERIES3.PULMONARY EMBOLISM4.CENTRAL RETINAL ARTERY THROMBOSIS5.DEEP VEIN THROMBOSIS
OTHER DOSES-250,000 UNITS INTRAVENOUS INFUSION OVER 30 MIN, THEN 100,000 UNITS EVERYHOUR FOR UPTO12-72 HOURS
ALTEPLASE(RECOMBINANT) TISSUE-TYPE PLASMINOGEN ACTIVATOR. RECOMBINANT FIBRINOLYTIC
USEACUTE MYOCARDIAL INFARCTION (TOTAL DOSE 100MG-REGIMEN DEPENDS ON TIME SINCE ONSET OF PAIN0-6HOURS: 15 MG INTRAVENOUS BOLUS,FOLLOWED BY 50 MG INTRAVENOUS INFUSION OVER 30 MINUTES AND 35 MG INTRAVENOUS INFUSION OVER 60 MINUTES6-12 HOURS-10 MG INTRAVENOUS BOLUS FOLLOWED BY 50 MG INTRAVENOUS INFUSION OVER 60 MIN, AND FOUR FURTHER 10 MG INTRAVENOUS INFUSIONS, EACH OVER 30 MIN)
DECREASE DOSE IF PATIENT WEIGHS LESS THAN 65 KG
RETEPLASERECOMBINANT PLASMINOGEN ACTIVATOR; THROMBOLYTICUSED ONLY FOR MYOCARDIAL INFARCTIONDOSE-10 UNITS AS SLOW INTRAVENOUS INJECTION OVER 2 MINUTES, REPEAT AFTER 30 MIN
Recommended