Anti-Anginals

• Congestive Heart Failure (CHF)


  When the heart muscle (myocardium) weakens & enlarges, it loses its ability to pump blood through the heart & into the systemic circulation
• Cardiac Glycosides


  • Positive inotropic action increases myocardial contraction stroke volume
  • Negative chronotropic action decreases heart rate
  • Negative dromotropic action decreases conduction of heart cells
• Cardiac-altered functions that can contribute to digoxin-induced ventricular dysrhythmias


  • Suppression of AV conduction
  • Increased automaticity
  • Decreased refractory period in ventricular muscle
• Digoxin-immune Fab


  Binds with digoxin to form complex molecules that can be excreted in the urine, thus digoxin is unable to bind at the cellular site of action
• Beta Blockers


  • Selective beta blockers are the group of choice for controlling angina pectoris
  • Block the beta1- & beta2-receptor sites
  • Decrease the effects of the sympathetic nervous system by blocking the action of the catecholamines, epinephrine & norepinephrine, decreasing the HR & BP
  • Used as antianginal, antidysrhythmic & antihypertensive drugs
  • Effective as antianginals because by decreasing the HR & myocardial contractility they reduce the need for oxygen consumption & consequently reduce anginal pain
  • Most useful for classic (stable) angina
• Selective beta blockers


  • Block the beta1- & beta2-receptor sites
  • Decrease the effects of the sympathetic nervous system by blocking the action of the catecholamines, epinephrine & norepinephrine
  • Decrease the HR & BP
• Calcium channel blockers


  Verapamil, nifedipine, and diltiazem
• Calcium channel blockers


  • Use for the treatment of stable and variant angina pectoris, certain dysrhythmias & hypertension
  • Relax coronary artery spasm (variant angina) & relax peripheral arterioles (stable angina), decreasing cardiac oxygen demand
  • Decrease cardiac contractility
• Cardiac dysrhythmia (arrhythmia)


  Any deviation from the normal rate or pattern of the heartbeat
• Dysrhythmia (disturbed heart rhythm)


  Arrhythmia (absence of heart rhythm) are used interchangeably
• Antidysrhythmic (antiarrhythmic) drugs


  • Action is to restore the cardiac rhythm to normal
• Four classes of antidysrhythmic drugs


  • Sodium (fast) channel blockers IA, IB, IC
  • Beta blockers
  • Potassium channel blockers
  • Calcium (slow) channel blockers
• Class I: Sodium channel blockers

  • Decreases sodium influx into cardiac cells
  • Decreases conduction velocity in cardiac tissues; suppression of automaticity, which decreases the likelihood of ectopic foci & increased recovery time (repolarization or refractory period)
• MOA: Class 1(Sodium Channel Blockers)

  • Class 1 A - Quinidine, Procainamide, Disopyramide, Moricizine
  • Class 1 B - Lidocaine, Mexiletine, Tocainide
  • Class 1 C - Encainide, Flecainide, propafenone
• Class II: Beta blockers


  • Decrease conduction velocity, automaticity & recovery time (refractory period)
  • More frequently prescribed for dysrhythmias than are sodium channel blockers
• Class III: Potassium channel blockers


  • Sotalol, bretylium, amniodarone
• Class III: Potassium channel blockers

  • Prolong repolarization & are used in emergency treatment of ventricular dysrhythmias when other antidysrhythmics are ineffective
  • Amiodarone increases the refractory period (recovery time) & prolongs the action potential duration (cardiac cell activity)
• Class IV: Calcium channel blockers

  • Verapamil & Diltiazem
  • Slow (calcium) channel blocker that blocks calcium influx decreasing the excitability & (negative inotropic) contractility of the myocardium
  • Increases the refractory period of the AV node which decreases ventricular response
  • Contraindicated for patients with AV block or HF