10. Drugs Used in Unstable Angina: CVS Pharmacology

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10. Drugs Used in Unstable Angina: Pharmacology Video Lectures
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Unstable angina (UA) is a medical emergency and a critical component of acute coronary syndrome (ACS), characterized by chest pain at rest, increasing in frequency, severity, or duration, and not relieved by nitroglycerin or rest, indicating partial occlusion of a coronary artery due to plaque rupture and thrombosis ????????. The primary goal of pharmacological management in unstable angina is to prevent myocardial infarction (MI), reduce ischemia, and stabilize the plaque ????????.
???? Antiplatelet Therapy: Aspirin (81-325 mg daily) is the first-line drug, inhibiting cyclooxygenase-1 (COX-1), preventing thromboxane A2 formation, and reducing platelet aggregation ????????. P2Y12 inhibitors (Clopidogrel, Ticagrelor, Prasugrel) further block ADP-induced platelet activation, reducing thrombus formation and lowering the risk of major cardiac events ????????.
???? Anticoagulants: Unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH - Enoxaparin, Dalteparin) inhibit thrombin and factor Xa, preventing clot propagation and embolization ????⚠️. Direct oral anticoagulants (DOACs, such as Rivaroxaban) or Fondaparinux (a selective Xa inhibitor) may also be used in high-risk patients ????????.
???? Nitrates (Nitroglycerin, Isosorbide Mononitrate/Dinitrate): These drugs vasodilate coronary arteries, reduce preload and afterload, and improve myocardial oxygen supply, helping relieve ischemic pain ????????. Sublingual nitroglycerin is given immediately for acute pain relief, followed by IV nitroglycerin if symptoms persist ????????.
???? Beta-Blockers (Metoprolol, Atenolol, Carvedilol, Propranolol): By blocking β1-adrenergic receptors, these drugs reduce heart rate, myocardial contractility, and oxygen demand, preventing further ischemic damage and improving survival in ACS patients ⏳????. They are contraindicated in cardiogenic shock, heart block, and severe bradycardia ⚠️????.
???? Calcium Channel Blockers (Diltiazem, Verapamil, Amlodipine, Nifedipine): Used when beta-blockers are contraindicated, these drugs reduce myocardial oxygen demand, dilate coronary arteries, and prevent vasospasm, particularly in vasospastic (Prinzmetal’s) angina ????????.
???? Statins (Atorvastatin, Rosuvastatin, Simvastatin): High-intensity statins are started immediately to lower LDL cholesterol, stabilize atherosclerotic plaques, and reduce inflammation, preventing future cardiovascular events ????????.
???? Glycoprotein IIb/IIIa Inhibitors (Abciximab, Eptifibatide, Tirofiban): These potent IV antiplatelet agents prevent platelet aggregation and thrombus formation, particularly in high-risk patients undergoing percutaneous coronary intervention (PCI) ????????.
???? Morphine: Used selectively for persistent chest pain despite nitrates and beta-blockers, morphine reduces sympathetic drive, relieves pain, and decreases oxygen demand, but must be used with caution due to risk of respiratory depression and hypotension ????????.
???? Revascularization (PCI or CABG): If pharmacologic therapy fails, angioplasty with stent placement (PCI) or coronary artery bypass grafting (CABG) is considered to restore coronary blood flow in high-risk patients ????????.
The management of unstable angina requires rapid intervention, aggressive antiplatelet and anticoagulant therapy, and close monitoring to prevent progression to myocardial infarction or sudden cardiac death ????????. Early recognition, risk stratification, and guideline-directed therapy are essential for improving patient outcomes and long-term cardiac health ❤️????.

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