9. Drugs used in Stable Angina: CVS Pharmacology

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9. Drugs used in Stable Angina: CVS Pharmacology
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Stable angina is a chronic condition caused by myocardial ischemia due to fixed atherosclerotic narrowing of coronary arteries, leading to chest pain during exertion or emotional stress when oxygen demand exceeds supply ????????. The primary goal of pharmacological therapy is to reduce myocardial oxygen demand, enhance oxygen supply, and prevent progression to acute coronary syndrome (ACS) or myocardial infarction (MI) ????????. The key drug classes used in stable angina include:

???? Nitrates (Nitroglycerin, Isosorbide Mononitrate, Isosorbide Dinitrate): These drugs act by releasing nitric oxide (NO), leading to vasodilation, reducing preload (venodilation) and afterload (arterial dilation) ????????. This results in reduced myocardial oxygen consumption, alleviating chest pain rapidly in acute attacks ????????. However, tolerance develops with prolonged use, requiring nitrate-free intervals ????⚠️.

???? Beta-Blockers (Metoprolol, Atenolol, Propranolol, Carvedilol): These drugs block β-adrenergic receptors, reducing heart rate (negative chronotropy), contractility (negative inotropy), and blood pressure (afterload reduction) ⏳????. By prolonging diastole, beta-blockers enhance coronary perfusion and are particularly beneficial in post-MI patients ????. Contraindicated in vasospastic (Prinzmetal’s) angina due to the risk of unopposed alpha-mediated vasoconstriction ⚠️????.

???? Calcium Channel Blockers (Dihydropyridines – Amlodipine, Nifedipine; Non-DHP – Verapamil, Diltiazem): These drugs block L-type calcium channels, leading to arterial vasodilation (DHPs) or decreased cardiac contractility and heart rate (Non-DHPs) ????????. They are first-line for vasospastic (Prinzmetal’s) angina and used when beta-blockers are contraindicated ????????.

???? Ranolazine (Partial Fatty Acid Oxidation Inhibitor): A newer anti-anginal drug that reduces intracellular calcium overload, improving diastolic relaxation without affecting heart rate or blood pressure ????????. It is an excellent add-on therapy for chronic stable angina ????⚕️.

???? Antiplatelet Therapy (Aspirin, Clopidogrel, Ticagrelor): These drugs prevent platelet aggregation and thrombus formation, reducing the risk of coronary artery occlusion and MI ????⚠️. Aspirin (81-325 mg daily) is the first-line drug for all angina patients ????????.

???? Lipid-Lowering Agents (Statins – Atorvastatin, Rosuvastatin): Since atherosclerosis is the primary cause of angina, statins lower LDL cholesterol, stabilize plaques, and reduce inflammation, slowing disease progression and reducing cardiovascular events ????????.

???? ACE Inhibitors (Enalapril, Ramipril) & ARBs (Losartan, Valsartan): Used in hypertensive and diabetic patients with angina, these drugs reduce afterload, improve endothelial function, and prevent left ventricular remodeling ????????.

A combination of these drugs is often used based on patient-specific factors to provide optimal angina control while preventing cardiovascular complications ????????. Lifestyle modifications (smoking cessation, diet, exercise) and risk factor management (diabetes, hypertension, dyslipidemia) are equally crucial in stable angina management ????????. #StableAngina #CVSPharmacology #HeartHealth #AnginaTreatment #Nitrates #BetaBlockers #CalciumChannelBlockers #Aspirin #Statins #Ranolazine #Antiplatelets #Hypertension #CoronaryArteryDisease #Cardiology #MedicalScience #USMLE #NEETPG #GlobalHealth #SaveHearts #CardiacCare #RationalDrugUse