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Angina And Acs Ii Notes

Pharmacology Notes > Drug Development (BIOL10822) Notes

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Drugs: From Molecules to Man - Lecture 15 (19/03/2018)

ACS II: Drugs used to treat Stable Angina
Angina and Acute Coronary Syndrome

Both Angina and Acute Coronary Syndrome involve chest pains caused by cardiac ischemia (restriction of blood supply).

Stable Angina can be resolved with rest after a few minutes.
ACS does not resolve quickly or with rest.

ACS is unstable angina which can result in an Non-ST elevated myocardial infarction
(NSTEMI) or an ST elevated myocardial infarction (STEMI).

Non- Pharmacological Interventions

There are 2 main non-pharmacological interventions that are commonly performed against
ACS and Angina.

Angioplasty - Angioplasty involves opening up a stenosis using a thin wire inserted into the circulation. A tiny balloon is sometimes then inflated (balloon angioplasty). The blockage is kept open using a wire framework called a stent. This is very effective and is a minimally invasive technique. It can be used to treat a heart attack (if done quickly) or to treat angina.

Bypass Surgery - Bypass surgery can also be used for angina. It involves taking a blood vessel from another part of the body and grafting it into the heart. It is more effective in improving function than drugs or angioplasty but carries the risk of cognitive decline (decline in mental function) due to embolism and "microstrokes" after surgery.

Angina pectoris

Angina Pectoris is a crushing pain in the chest that may radiate to the arm,
neck or jaw, creating the feeling of a "strangling of the chest".
This pain results from cardiac ischaemia.
Angina is a chronic, but paroxysmal (occurring in attacks), condition that manifests itself as a crushing pain in the chest.
This pain may radiate to the left arm, shoulder and jaw.

It arises from ischaemia. When cardiac muscle cells become ischaemic they release pain mediators such as adenosine, bradykinin and potassium.

Angina is often triggered by stress or exercise. There are several different types, including Stable and Unstable angina. Stable Angina (Angina of Effort)

Stable Angina is the most common form of Angina.
It is caused by Atherosclerosis of the coronary arteries.
Stable Angina can be caused by exercise, excitement and cold weather.
Stable Angina can be relieved through rest.

Unstable (Brittle) Angina

Unstable Angina is associated with the disruption of a pre-existing atherosclerotic plaque or the superimposition of a thrombus (blood clot).

These attacks may occur at rest and can wake the patient from sleep.
These have high risk of progression to a myocardial infarction.

The Treatment of Angina

The problem angina presents is that too little oxygen is getting to the cardiac muscle.

The solutions for this include reducing the oxygen demand (reducing workload) or increasing the oxygen supply (improving bloodflow).

Stable Angina can be treated through the use of Aspirin, to prevent platelet aggregation, or
Statins, which work as a lipid lowering drug that prevents a plaque formation.

It can also be treated through the use of organic nitrates and antagonistic β-adrenoceptors,
Ca2+ Channel blockers and K+ Channel Activators (Which promote vasodilation).

First Pass Metabolism

Enteral (oral) drugs need to be absorbed from the GI
tract and this takes them on a journey via the liver.

Many drugs do not survive this journey, so other ways of drug administration need to be performed.

Different ways of Drug Administration

There are many different ways of administering drugs including topical transdermal (creams),
parenteral (injections) and mucous membrane.

IV = Intravenous.
CSF = Cerebrospinal fluid.
IT = Intrathecal
IM = Intramuscular.
SC = Subcutaneous.
Buccal = Into the mouth cavity.
Sublingual = Under the tongue.

The Nitrovasodilators

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