Why do patients with coronary atherosclerotic heart disease take pill under the tongue instead of swallowing? Analyze and explain in details covering all possible reasons.

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Patients with coronary atherosclerotic heart disease often take medications like nitroglycerin under the tongue instead of swallowing them. This method, known as sublingual administration, is preferred for several important reasons that we'll explore in this video. The key question is: why is this route of administration so beneficial for heart disease patients? The first major reason for sublingual administration is rapid absorption. The area under the tongue is extremely rich in blood vessels and capillaries. When nitroglycerin is placed under the tongue, it dissolves quickly and enters the bloodstream directly. This route completely bypasses the digestive system, allowing the medication to take effect within just 1 to 3 minutes. For patients experiencing acute angina or chest pain, this rapid onset of action is crucial for providing quick relief and preventing further damage to the heart muscle. The second major advantage of sublingual administration is avoiding first-pass metabolism. When medications are swallowed, they travel through the digestive system and are absorbed into the portal vein, which carries blood directly to the liver. The liver is the primary site for drug metabolism, where many medications, including nitroglycerin, are extensively broken down before reaching the general circulation. This process, known as first-pass metabolism, significantly reduces the amount of active drug that reaches the target tissues. By administering nitroglycerin under the tongue, it enters the systemic circulation directly, bypassing the liver's first-pass effect. This ensures that a higher concentration of the active drug reaches the heart and blood vessels, making it much more effective at a lower dose. The third critical reason for sublingual administration is the urgent clinical need for speed in treating angina. Angina is a sign of myocardial ischemia, which means the heart muscle isn't getting enough oxygen. This occurs when coronary arteries are narrowed by atherosclerotic plaques, restricting blood flow. Prompt treatment is absolutely necessary to restore the balance between oxygen supply and demand in the heart muscle. Without quick intervention, ischemia can progress to myocardial infarction, or heart attack, where heart tissue actually dies. Sublingual nitroglycerin works by dilating blood vessels, including the coronary arteries, which improves blood flow to the heart muscle. The rapid action achieved through sublingual administration can make the difference between reversible ischemia and permanent heart damage. To summarize what we've learned about sublingual medication in coronary heart disease: First, sublingual nitroglycerin provides rapid relief for patients with coronary atherosclerotic heart disease by quickly dilating blood vessels. Second, the rich network of blood vessels under the tongue allows for rapid absorption, with onset of action within just 1 to 3 minutes. Third, this route bypasses first-pass metabolism in the liver, ensuring that more of the active medication reaches the heart where it's needed. Fourth, this quick action is critical in preventing the progression from reversible ischemia to permanent heart damage. Finally, the sublingual route is also convenient for patients who may be experiencing pain or difficulty swallowing during an angina attack. These combined advantages make sublingual administration the preferred route for nitroglycerin and similar medications in treating coronary heart disease.