Anti-anginal drugs | Important drugs of the cardiovascular system | Pharmacology

Drug	Features
Nitrates: nitroglycerine (acts within minutes sublingually), isosorbide mono and dinitrate is longer acting	Anti-anginal effect is due to decreased preload thereby reducing myocardial oxygen demand; decrease coronary vasospasm in Prinzmetal’s angina; dilate epicardial coronary arteries
Calcium channel blockers	Non-dihydropyridines preferred such as diltiazem and verapamil
Beta blockers	Antianginal effect due to beta 1 blockade, decreases heart rate and contractility, decreases myocardial oxygen requirements; atenolol, metoprolol, carvedilol preferred
Ranolazine	It reduces sodium influx during ventricular depolarization by blocking Na channels; may prolong QTc; adverse effects include dizziness, edema, tinnitus, vertigo, constipation, dry mouth, asthenia, palpitations, hypotension
Dipyridamole (persantine)	Acts as vasodilator and platelet inhibitor, inhibits enzyme phosphodiesterase, increases cAMP; adverse effects include dizziness, diarrhea, headache, flushing,arthralgia, bleeding tendencies
Ivabradine	Inhibits funny currents in SA node, decreases heart rate; levels affected by drugs acting on Cyt P450 enzymes; adverse effects include blurred vision, gastrointestinal upset, AF, prolongation of QTc, bradycardia
Trimetazidine	Increases myocardial resistance to ischemia by decreasing beta oxidation of fatty acids thereby decreasing oxygen demand; cytoprotective effect; adverse effects include nausea, vomiting, thrombocytopenia, agranulocytosis, hepatic dysfunction, may worsen Parkinson syndrome