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A. Mechanism of action
Nitrates inhibit coronary vasoconstriction or spasm,
increasing perfusion of the myocardium and,
thus, relieving vasospastic angina. In addition,
nitrates relax the veins (venodilation), decreasing
preload and myocardial oxygen consumption.
C. Pharmacokinetics
The time to onset of action varies from 1 minute for
nitroglycerin to more than 1 hour for isosorbide
mononitrate.
Significant first-pass metabolism of nitroglycerin occurs in the
liver. Therefore, it is common to take the drug either
sublingually or via a transdermal patch, thereby avoiding
this route of elimination.
Isosorbide mononitrate owes its improved bioavailability and
long duration of action to its stability against hepatic
breakdown.
Oral isosorbide dinitrate undergoes denitration to two
mononitrates, both of which possess antianginal activity.
Time to peak effect
and duration
of action for some
common organic
nitrate preparations
Organic nitrates
Adverse effects
The most common adverse effect of
nitroglycerin, as well as of the other nitrates, is
headache.
High doses of organic nitrates can also cause
postural hypotension, facial flushing, and
tachycardia.
β-blockers
↓ the oxygen demands
They suppress the activation of the heart by
blocking β1 receptors,
↓ the work of the heart by decreasing heart
rate, contractility, cardiac output, and blood
pressure.
With β-blockers, the demand for oxygen by the
myocardium is reduced both during exertion and at
rest. Because of these effects, β-blockers are the
drugs of choice to treat effort-induced angina.
C. Diltiazem
has cardiovascular effects that are similar to those of verapamil. Both
drugs slow AV conduction and decrease the rate of firing of the sinus
node pacemaker.
reduces the heart rate, although to a lesser extent than verapamil, and
also decreases blood pressure.
• Disritmia (verapamil)
- utk memperlambat denyut ventrikel pd
fibrilasi atrial
- mencegah kekambuhan takikardia
supraventrikular
• Hipertensi
• Mencegah angina (biasanya gol dihidropiridin
atau diltiazem)
Efek samping
• Konstipasi, dizziness, headache, fatigue
• Verapamil harus dihindari pd pasien
gagal jantung kongestif krn efek
inotropik negatifnya
SODIUM-CHANNEL BLOCKER
A. Ranolazine
Ranolazine inhibits the late phase of the sodium current
(late INa) improving the oxygen supply-and-demand
equation. Inhibition of late INa reduces intracellular
sodium and calcium overload, thereby improving
diastolic function.
Ranolazine is indicated for the treatment of chronic
angina and may be used alone or in combination with
other traditional therapies, but is most often used as
an option in angina patients who have failed all other
antianginal therapies. It is not to be used to treat an
acute attack of angina.