logging in or signing up IVMS-CV Pharmacology -Anti-Aniginal Agen RBGStreetScholar Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 434 Category: Education License: All Rights Reserved Like it (2) Dislike it (0) Added: October 17, 2009 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... By: suzane89 (18 month(s) ago) Angina pectoris, commonly known as angina, is chest pain due to heart muscle disease, generally due to obstruction or spasm of the coronary arteries. Unstable angina is defined by angina, which changes or worsens. There are at least one of these three characteristics: It takes place elsewhere, usually lasts longer than 10 minutes. This is a serious and new onset i.e before 4-6 weeks and shows a flagship model, apparently more serious, prolonged or frequent than previously. http://www.insideheart.com/unstable-angina-pectoris.html Saving..... Post Reply Close Saving..... Edit Comment Close By: dr.r0r0 (19 month(s) ago) I like it Saving..... Post Reply Close Saving..... Edit Comment Close By: RBGStreetScholar (28 month(s) ago) HERE ARE PDF'S OF THEM, QUESTIONS AND ANSWER/EXPLAINATIONS TO REVIEW http://www.scribd.com/people/documents/15606897/folder/138057 Saving..... Post Reply Close Saving..... Edit Comment Close By: RBGStreetScholar (28 month(s) ago) I SELL ALL POWERPOINT SUBJECTS IN PHARM/YOU CAN MODIFY ONCE PURCHASED Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript CV PharmacologyAnti-Anginal Agents : CV PharmacologyAnti-Anginal Agents Prepared and Presented: Marc Imhotep Cray, M.D. Professor Pharmacology Recommended Reading: Antianginal Drugs Formative Assessment Practice question Clinical: E-Medicine Article Angina Pectoris Coronary Artery Disease Coronary heart disease (CHD) Defined (Etiologic Dx) : 10/17/2009 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. Causes (Anatomic Dx) : 10/17/2009 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 Slide 4: 10/17/2009 4 CAD Risk Factors : 10/17/2009 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 Symptoms : 10/17/2009 6 Symptoms Some more frequent symptoms of coronary heart disease include: Angina (ischemic pain) Myocardial Infarction Shortness of breath Diagnosis : 10/17/2009 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 Treatment : 10/17/2009 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 Coronary Artery O2 Supply and Demand : 10/17/2009 9 Coronary Artery O2 Supply and Demand Angina Pectoris (Chest Pain) : 10/17/2009 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] R/O MI Algorithm : 10/17/2009 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= Antianginal Pharmacologic Agents : 10/17/2009 12 Antianginal Pharmacologic Agents Nitrates Beta blockers Calcium channel blockers Types of Angina : 10/17/2009 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) Antianginal Agents: : 10/17/2009 14 Antianginal Agents: Therapeutic Objectives Increase blood flow to ischemic heart muscle and/or Decrease myocardial oxygen demand Antianginal Agents: : 10/17/2009 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 Antianginal Agents: 1)Nitrates : 10/17/2009 16 Antianginal Agents: 1)Nitrates Available forms: Sublingual Ointments Buccal Transdermal patches Chewable tablets Inhalable sprays Capsules Intravenous solutions Antianginal Agents: Nitrates : 10/17/2009 17 Antianginal Agents: Nitrates Cause vasodilation due to relaxation of smooth muscles Potent dilating effect on coronary arteries Used for prophylaxis and treatment of angina Antianginal Agents: Nitrates : 10/17/2009 18 Antianginal Agents: Nitrates 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 Antianginal Agents: Nitrates : 10/17/2009 19 Antianginal Agents: Nitrates 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 Antianginal Agents: Nitrates : 10/17/2009 20 Antianginal Agents: Nitrates Side Effects Headache Usually diminish in intensity and frequency with continued use Tachycardia, postural hypotension Tolerance may develop Antianginal Agents: 2)Beta Blockers : 10/17/2009 21 Antianginal Agents: 2)Beta Blockers atenolol (Tenormin) metoprolol (Lopressor) propranolol (Inderal) nadolol (Corgard) Antianginal Agents: Beta Blockers : 10/17/2009 22 Antianginal Agents: Beta Blockers 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 Antianginal Agents: Beta Blockers : 10/17/2009 23 Antianginal Agents: Beta Blockers Therapeutic Uses Antianginal Antihypertensive Cardioprotective effects, especially after MI Antianginal Agents: Beta Blockers : 10/17/2009 24 Antianginal Agents: Beta Blockers Side Effects Body System Effects Cardiovascular bradycardia, hypotension second- or third-degree heart block heart failure Metabolic Altered glucose and lipid metabolism Antianginal Agents: Beta Blockers : 10/17/2009 25 Antianginal Agents: Beta Blockers Side Effects Body System Effects CNS dizziness, fatigue, mental depression, lethargy, drowsiness, unusual dreams Other impotence wheezing, dyspnea Antianginal Agents: 3) Calcium Channel Blockers : 10/17/2009 26 Antianginal Agents: 3) Calcium Channel Blockers verapamil (Calan) diltiazem (Cardizem) nifedipine (Procardia) Antianginal Agents: Calcium Channel Blockers : 10/17/2009 27 Antianginal Agents: Calcium Channel Blockers Mechanism of Action Cause peripheral arterial vasodilation Reduce myocardial contractility (negative inotropic action) Result: decreased myocardial oxygen demand Antianginal Agents: Calcium Channel Blockers : 10/17/2009 28 Antianginal Agents: Calcium Channel Blockers Therapeutic Uses First-line agents for treatment of angina, hypertension, and supraventricular tachycardia Short-term management of atrial fibrillation and flutter Several other uses Antianginal Agents: Calcium Channel Blockers : 10/17/2009 29 Antianginal Agents: Calcium Channel Blockers Side Effects Very acceptable side effect and safety profile May cause hypotension, palpitations, tachycardia or bradycardia, constipation, nausea, dyspnea Cardiovascular Animations and Interactive Tutorials : 10/17/2009 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 Cardiovascular Animations and Interactive Tutorials(2) : 10/17/2009 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 Free Useful Plugins : 10/17/2009 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 Free Useful Plugins : 10/17/2009 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. 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IVMS-CV Pharmacology -Anti-Aniginal Agen RBGStreetScholar Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 434 Category: Education License: All Rights Reserved Like it (2) Dislike it (0) Added: October 17, 2009 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... By: suzane89 (18 month(s) ago) Angina pectoris, commonly known as angina, is chest pain due to heart muscle disease, generally due to obstruction or spasm of the coronary arteries. Unstable angina is defined by angina, which changes or worsens. There are at least one of these three characteristics: It takes place elsewhere, usually lasts longer than 10 minutes. This is a serious and new onset i.e before 4-6 weeks and shows a flagship model, apparently more serious, prolonged or frequent than previously. http://www.insideheart.com/unstable-angina-pectoris.html Saving..... Post Reply Close Saving..... Edit Comment Close By: dr.r0r0 (19 month(s) ago) I like it Saving..... Post Reply Close Saving..... Edit Comment Close By: RBGStreetScholar (28 month(s) ago) HERE ARE PDF'S OF THEM, QUESTIONS AND ANSWER/EXPLAINATIONS TO REVIEW http://www.scribd.com/people/documents/15606897/folder/138057 Saving..... Post Reply Close Saving..... Edit Comment Close By: RBGStreetScholar (28 month(s) ago) I SELL ALL POWERPOINT SUBJECTS IN PHARM/YOU CAN MODIFY ONCE PURCHASED Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript CV PharmacologyAnti-Anginal Agents : CV PharmacologyAnti-Anginal Agents Prepared and Presented: Marc Imhotep Cray, M.D. Professor Pharmacology Recommended Reading: Antianginal Drugs Formative Assessment Practice question Clinical: E-Medicine Article Angina Pectoris Coronary Artery Disease Coronary heart disease (CHD) Defined (Etiologic Dx) : 10/17/2009 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. Causes (Anatomic Dx) : 10/17/2009 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 Slide 4: 10/17/2009 4 CAD Risk Factors : 10/17/2009 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 Symptoms : 10/17/2009 6 Symptoms Some more frequent symptoms of coronary heart disease include: Angina (ischemic pain) Myocardial Infarction Shortness of breath Diagnosis : 10/17/2009 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 Treatment : 10/17/2009 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 Coronary Artery O2 Supply and Demand : 10/17/2009 9 Coronary Artery O2 Supply and Demand Angina Pectoris (Chest Pain) : 10/17/2009 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] R/O MI Algorithm : 10/17/2009 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= Antianginal Pharmacologic Agents : 10/17/2009 12 Antianginal Pharmacologic Agents Nitrates Beta blockers Calcium channel blockers Types of Angina : 10/17/2009 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) Antianginal Agents: : 10/17/2009 14 Antianginal Agents: Therapeutic Objectives Increase blood flow to ischemic heart muscle and/or Decrease myocardial oxygen demand Antianginal Agents: : 10/17/2009 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 Antianginal Agents: 1)Nitrates : 10/17/2009 16 Antianginal Agents: 1)Nitrates Available forms: Sublingual Ointments Buccal Transdermal patches Chewable tablets Inhalable sprays Capsules Intravenous solutions Antianginal Agents: Nitrates : 10/17/2009 17 Antianginal Agents: Nitrates Cause vasodilation due to relaxation of smooth muscles Potent dilating effect on coronary arteries Used for prophylaxis and treatment of angina Antianginal Agents: Nitrates : 10/17/2009 18 Antianginal Agents: Nitrates 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 Antianginal Agents: Nitrates : 10/17/2009 19 Antianginal Agents: Nitrates 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 Antianginal Agents: Nitrates : 10/17/2009 20 Antianginal Agents: Nitrates Side Effects Headache Usually diminish in intensity and frequency with continued use Tachycardia, postural hypotension Tolerance may develop Antianginal Agents: 2)Beta Blockers : 10/17/2009 21 Antianginal Agents: 2)Beta Blockers atenolol (Tenormin) metoprolol (Lopressor) propranolol (Inderal) nadolol (Corgard) Antianginal Agents: Beta Blockers : 10/17/2009 22 Antianginal Agents: Beta Blockers 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 Antianginal Agents: Beta Blockers : 10/17/2009 23 Antianginal Agents: Beta Blockers Therapeutic Uses Antianginal Antihypertensive Cardioprotective effects, especially after MI Antianginal Agents: Beta Blockers : 10/17/2009 24 Antianginal Agents: Beta Blockers Side Effects Body System Effects Cardiovascular bradycardia, hypotension second- or third-degree heart block heart failure Metabolic Altered glucose and lipid metabolism Antianginal Agents: Beta Blockers : 10/17/2009 25 Antianginal Agents: Beta Blockers Side Effects Body System Effects CNS dizziness, fatigue, mental depression, lethargy, drowsiness, unusual dreams Other impotence wheezing, dyspnea Antianginal Agents: 3) Calcium Channel Blockers : 10/17/2009 26 Antianginal Agents: 3) Calcium Channel Blockers verapamil (Calan) diltiazem (Cardizem) nifedipine (Procardia) Antianginal Agents: Calcium Channel Blockers : 10/17/2009 27 Antianginal Agents: Calcium Channel Blockers Mechanism of Action Cause peripheral arterial vasodilation Reduce myocardial contractility (negative inotropic action) Result: decreased myocardial oxygen demand Antianginal Agents: Calcium Channel Blockers : 10/17/2009 28 Antianginal Agents: Calcium Channel Blockers Therapeutic Uses First-line agents for treatment of angina, hypertension, and supraventricular tachycardia Short-term management of atrial fibrillation and flutter Several other uses Antianginal Agents: Calcium Channel Blockers : 10/17/2009 29 Antianginal Agents: Calcium Channel Blockers Side Effects Very acceptable side effect and safety profile May cause hypotension, palpitations, tachycardia or bradycardia, constipation, nausea, dyspnea Cardiovascular Animations and Interactive Tutorials : 10/17/2009 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 Cardiovascular Animations and Interactive Tutorials(2) : 10/17/2009 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 Free Useful Plugins : 10/17/2009 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 Free Useful Plugins : 10/17/2009 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.