Principles of Therapy for Angina

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Chapter: Medicinal Chemistry : Antianginals

Pharmacological therapy to prevent myocardial infarction and death is with antiplatelet agents (aspirin, clopidogrel) and lipid lowering agents.


PRINCIPLES OF THERAPY FOR ANGINA

Pharmacological therapy to prevent myocardial infarction and death is with antiplatelet agents (aspirin, clopidogrel) and lipid lowering agents. Recently, angiotensin-converting enzyme (ACE) inhibitors have also reported to reduce the risk from coronary artery disease. In unstable angina and non-STsegment elevation myocardial infarction, and in coronary stenting, antilipid drugs, heparin, and antiplatelet agents are recommended.

Angina of effort: For therapy of chronic stable angina, long-acting nitrates, calcium channel blockers, or β blockers are chosen. The combination therapy has shown to be more effective than individual drugs used alone.

Vasospastic angina: Nitrites and calcium channel blockers are effective drugs for reducing and preventing ischaemic episodes in patients with variant angina. In approximately 70% of the patients treated with nitrites or calcium channel blockers, angina attacks are completely abolished.

Unstable and acute coronary syndromes: In patients with unstable angina with recurrent ischaemic episodes at rest, recurrent thrombotic occlusions of the offending coronary artery occur as the result of fissuring of atherosclerotic plagues and platelet aggregation. Anticoagulant and antiplatelet drugs play an important role in these cases.


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