Pharmacology · MU Sofia

42. Antianginal (antistenocardial) drugs.

Covers antianginal drugs used to manage angina pectoris caused by myocardial ischaemia, explaining how they reduce oxygen demand or raise supply. It classifies nitrates, calcium channel blockers, antithrombotics, beta-blockers and ranolazine, then sets out each class's mechanism, pharmacokinetics, side effects, interactions, therapeutic uses and pregnancy considerations. It ends with recap questions.

Inside: 9 sections · 6 labelled pictures · 10 flashcards · 5 min

Topic 41 of 93 in the MU Sofia syllabus for Pharmacology (Medicine, Year 3). The free AceMed note covers it in 9 sections, about 627 words (5 min of reading), with 10 flashcards.

In this note

  1. Antianginal Drugs
  2. Classification of Antianginal Drugs
  3. Pharmacodynamics (Mechanism of Action)
  4. Pharmacokinetics
  5. Side Effects
  6. Drug Interactions
  7. Therapeutic Uses
  8. Pregnancy & Breastfeeding Considerations
  9. Key Recap Questions

Antianginal Drugs

Antianginal drugs are used to manage and treat angina pectoris, a condition characterized by chest pain due to reduced blood flow (ischemia) to the heart. These drugs work by reducing myocardial oxygen demand and/or increasing oxygen supply to the heart.

Classification of Antianginal Drugs

  1. 1. Nitrates
  • Nitroglycerin, Isosorbide dinitrate
  1. 2. Calcium Channel Blockers (CCBs)
  • Amlodipine, Nifedipine, Verapamil, Diltiazem
  1. 3. Antithrombotic Agents
  • Anticoagulants (AC): Heparin, Warfarin
  • Antiplatelets (AP): Aspirin, Clopidogrel
  1. 4. Beta-Blockers (BBs)
  • Metoprolol, Atenolol, Bisoprolol
  1. 5. Other Agents
  • Ranolazine

Pharmacodynamics (Mechanism of Action)

  1. 1. Nitrates
  • Dilate veins and arteries, reducing preload (venous return) and afterload (arterial resistance).
  • Decrease myocardial oxygen demand and increase oxygen supply by improving coronary blood flow.
  • Example: Nitroglycerin, used sublingually for immediate angina relief.
  1. 2. Calcium Channel Blockers (CCBs)
  • Inhibit calcium influx into cardiac and smooth muscle cells, leading to vasodilation.
  • Reduce heart rate, contractility, and afterload, decreasing myocardial oxygen demand.
  • Dihydropyridines (Amlodipine, Nifedipine): Act mainly on vascular smooth muscle (vasodilation).
  • Non-dihydropyridines (Verapamil, Diltiazem): Act on both heart and vessels (reduce HR, contractility).
  1. 3. Antithrombotic Agents
  • Anticoagulants (Heparin, Warfarin): Prevent thrombus formation in coronary arteries.
  • Antiplatelets (Aspirin, Clopidogrel): Prevent platelet aggregation, reducing the risk of coronary occlusion.
  1. 4. Beta-Blockers (BBs)
  • Block beta-adrenergic receptors, reducing heart rate, contractility, and myocardial oxygen consumption.
  • Decrease sympathetic drive, improving exercise tolerance and reducing angina episodes.
  1. 5. Ranolazine
  • Inhibits late-phase sodium current in cardiac cells, reducing calcium overload and myocardial wall stress.
  • Does not affect heart rate or blood pressure, making it useful in patients with low BP or bradycardia.

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