How will you manage a case of Angina pectoris?

Table of contant in manage a case of Angina pectoris?

1Antianginal drug use
2The role of aspirin in reducing angina
3How aspirin improve anti anginal patient condition
4Contraindication of using aspirin
5Mechanism action of Clopidogrel
6Compare between using the aspirin and clopidogrel

A patient should go on complete bed rest. After that a doctor should follow this treatment guideline:

  1. Oxygen inhalation is given to patient to increase the oxygen concentration to the blood. Thus causes more oxygen supply to heart.
  2. Antiplatelet drugs use for producing anticoagulant effect. Thormbus may block the coronary artery, which does not allow blood to reach the myocardial cells. Antiplatlete helps clear the blockage of the heart and gives an uninterrupted blood supply to the myocardial tissue. Antiplatelet drugs are usually used in angina patients, such as :
  3. Low dose of aspirin (75 mg)
  4. Clopidegrel(75mg daily)

Antiplatelet drugs reduce the Risk of myocardial infarction patient.

1.Antianginal drug use :

Usually four groups of drugs are used in the treatment of angina and they are  nitrates, beta-blockers, calcium antagonists, and potassium channel Activators. They are the main drug used in angina, which can save a person’s life if he is suffering from unstable angina.

The role of aspirin in reducing angina:

Aspirin act as a anti anginal drug. it is considered as a antiplatelet drug. It inhibit the platelet aggregation and dissolution of platelet plug. only low dose of aspirin are considered as a antiplatelet drug. high dose of a aspirin does not considered as a antiplatelet drug and does not plays Role in reducing angina.

In the classification of Antiplatelete drug aspirin considered as cyclooxygenase inhibitor which  mainly act by the inhibition of thromboxan A2.

The dose of aspirin use  in antianginal  treatment :

the standard  using low dose  of aspirin amount is 75 -100 mg/day. In some book there is also include that the reference value of  low dose of Aspirin is 75-150 mg/day.

Mechanism of Low dose of aspirin as a antianginal  treatment:

The biochemical form of aspirin is acetylesalicylic acid> Acetylates inactivate cyclo oxygenos enzyme> this process is  irreversible> the platelets are unable to synthesis new enzyme which is needed for normal function of platelet> Cox activity is lost for the platelet for the lifetime, usually the lifespan of platelet is 8 to 10 days> this cox activity is needed for the formation both thromboxane A2 and prostacyclin> so  the function of thromboxane A2 and prostacyclin diminished > thromboxane A2 and prostacyclin has their different function on platelet, thromboxane A2 causes platelet aggregation but the prostacyclin inhibit the platelet aggregation> there is interesting fact in  using low dose of aspirin,  low dose of aspirin decrease synthesis of thromboxane  A2 but in other hand it doesn’t impaired the synthesis of prostacyclin > so the low dose of aspirin inhibit the platelet aggregation.

How aspirin improve anti anginal patient condition?

answer: low dose of aspirin preventing platelet aggregation by decreasing synthesis of thromboxane  A2. So in a word it  prevent the formation of thrombus. this is how aspirin prevent thromboembolic disease which is mainly caused by formation of thrombus  in the blood vessel. Thromboembolic diseases are ischemic stroke, deep vein thrombosis, and myocardial infraction.

Some indication where we can use low dose of aspirin:

1. Myocardial infraction

2. Ischemic stroke

3. Unstable angina

4. Peripheral vascular disease

5. Transient ischemic attacks

6. Coronary artery angioplasty and bypass grafting

7. Deep vein thrombosis

8. Atrial fibrillation

These are the condition where we can use low dose of aspirin as a treatment purpose. In those condition aspirin can  plays a important role in treatment.

Adverse or side-effect of using low dose of aspirin:

1. Gastric irritation or gastric discomfort

2. Gastric bleeding or gastric hemorrhage

3. Drug induced gastric perforation

4. Induction of asthma

We can’t use aspirin in those patient who are suffering from or contraindication of using aspirin:

1. Peptic ulcer disease

2. Coagulative disorder patient

3. Patient suffering from asthma or any respiratory disease

4. Chronic obstructive Pulmonary disease

5. Pregnant mother in 1st trimester

There are also some drug widely use on anti-anginal treatment as a anti-platelet  drug.Clopidogrel is the one of the best drug in treatment of angina

Mechanism action of Clopidogrel:

Clopidogrel bind  with the ADP receptor on the platelet membrane and Irreversibly blocks the action of ADP> No activation of glycoprotein IIIa/IIb receptor present on the platelet membrane, which is required for platelet to bind with the fibrinogen and one platelet to another platelet> which prevent platelet  aggregation which causes anti platelet effect> by preventing platelet aggregation prevent the formation of thrombus, this is the way clopidogrel prevent from Thromboembolic Disease such as myocardial infraction, cerebral stroke.

There are some adverse effect such as causing nausea, dyspepsia, hemorrhage, diarrhoea,there will also develop blood abnormalities such as neutropenia agranulocytosis, aplastic anaemia.

Now let’s compare between using the aspirin and clopidogrel:

1. Mechanism of action of aspirin by the inhibition of thromboxane A2 synthesis, On the other hand clopidegrel blocks ADP receptor which is present on platelet  membrane.

2. In case of aspirin there is present of  anti-inflammatory effect but in clopidpgrel there is absence of anti inflammatory effect.

3.Aspirin has a antipyretic  effect, On other hand clopidogrel does not induce any kind of antipyretic effect.

4. As antiplatelet action clopidogrel is much more effective then Aspirin.

5. Aspirin does not causes thrombocytopenic purpura as a adverse effect But clopidogrel causes thrombocytopenic purpura.

Now suppose a patient come to you and he is suffering from Myocardial infraction with bronchial asthma which antiplatelet drug will you prescribe:  The right answer is clopidogrel. In this case clopidogrel is the drug o choose.

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