TREATMENT Common drugs that are used along

with their mechanism of action.

Other Medical/Surgical treatments.

Anti-hypertensive drug. Principal action-Vasodilation(more effect on veins than

arteries). Dilation of veins- causesPreload(Venous Return). Dilation of arteries- causes Afterload(Peripheral

Resistance and thus B.P.). Long-acting nitrates: SorbitrateMechanism of Action- Nitro-glycerine forms free radical nitric oxide (NO)-

POTENT VASODILATOR-which activates guanylate cyclase, resulting in an increase of guanosine 3'5' monophosphate (cyclic GMP) in smooth muscle and other tissues.

These events lead to dephosphorylation of myosin light chains, which regulate the contractile state in smooth muscle, and result in vasodilatation.

Nitroglycerin(TNG)

WHY SUBLINGUAL ADMINISTRATION?

Refers to the pharmacological route of administration by which drugs diffuse into the blood through tissues “under the tongue”.

When a chemical comes in contact with the mucous membrane beneath the tongue, it diffuses through it. Because the connective tissue beneath the epithelium contains a profusion of capillaries, the substance then diffuses into them and enters the venous circulation.

Advantages over Oral administration-1. Bypasses the “Pre Systemic First-Pass Metabolism” in liver.2. Decreased risk of degradation as exposure is only against

salivary enzymes and not the hostile GIT enzymes in the lumen or gut wall or bacterial enzymes or hepatic enzymes.

3. Being more direct, it has faster activity.

ANTI-PLATELET DRUGS

To prevent ischemia, all patients diagnosed with CAD or at high risk of developing CAD should take an antiplatelet drug daily.

They inhibit platelet aggregation. Aspirin binds irreversibly to platelets and inhibits

cyclooxygenase and platelet aggregation. Clopidogrel or

ticagrelol blocks adenosine diphosphate– induced platelet aggregation.

𝜷𝐁𝐥𝐨𝐜𝐤𝐞𝐫𝐬 Limit symptoms and prevent infarction and sudden

death better than other drugs.  β-Blockers block sympathetic stimulation of the

heart and reduce systolic BP, heart rate, contractility, and cardiac output, thus decreasing myocardial O 2 demand and increasing exercise tolerance. 

Eg: Propanolol, Bucindolol,Carteolol. Depending upon the tolerance of the individual,

various cardioselective blockers are available

CALCIUM CHANNEL BLOCKERS Particularly useful if hypertension or coronary spasm is also present. Dihydropyridines (eg, nifedipine, amlodipine, felodipine) have no chronotropic effects and

vary substantially in their negative inotropic effects.  Amlodipine has the weakest negative inotropic effects; it may be used in patients with LV

systolic dysfunction. Diltiazem and verapamil, have negative chronotropic and inotropic effects- can be used alone

in patients with β-blocker intolerance. CCBs used as medications primarily have four effects:1)By acting on vascular smooth muscle cause-vasodilation (CCBs do not work on venous smooth muscle).2)By acting on cardiac muscles (myocardium), they reduce the force of contraction of the heart.3)By slowing down the conduction of electrical activity within the heart, they slow down the heart beat.4)By blocking the calcium signal on adrenal cortex cells, they directly reduce aldosterone production, which corroborates to lower blood pressure.

REVASCULARIZATION

Considered if angina persists despite drug therapy and worsens quality of life or if anatomic lesions (noted during angiography) put a patient at high risk of mortality. 

Either Percutaneous Coronary Intervention(PCI) or Coronary Artery Bypass Grafting(CABG).

PCI stenting(Coronary Angioplasty)- is usually preferred for 1- or 2-vessel disease with suitable anatomic lesions and is increasingly being used for 3-vessel disease. Lesions that are long or near bifurcation points are often not amenable to PCI. 

CABG- is very effective in selected patients with severe angina pectoris and localized disease, or diabetes mellitus. About 85% of patients have complete or dramatic symptom relief. 

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