Drugs For Myocardial Infraction

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1. Drugs for Myocardial Infraction PBL Group D

2. What is Myocardial infarction (MI) ? Rapid development of myocardial necrosis due to a critical imbalance between O2 supply and myocardial demand Also known as “ Heart attack ”

3. Goal Of Drug Therapy The most important goal of drug therapy early in the course of acute myocardial infarction is to improve the oxygen supply/demand ratio for the heart . There are two strategies to improve the coronary supply/demand ratio: - Restore normal coronary blood flow and, -Decrease myocardial oxygen consumption.

4. To restore normal coronary blood flow Nitrates Anti-Platelet Anti-coagulants Thrombolytics

5. Nitrates Glyceral trinitrate (GTN, Nitroglycerine ) ANGISED 0.5 mg tab Isosorbide dinitrate Sorbitrate 5, 10 mg tab

6. Contraindications: Should not be administered if: Systolic BP < 90 mmHg Heart rate < 50 or > 100 beats/min Right ventricular infarction is suspected Patient have taken Sildenafil in past 24 hrs. Uses: Besides Myocardial Infarction, also used in: Stable angina and Unstable angina Congestive heart failure Biliary colic Esophageal spasm. Cyanide poisoning Acute left ventricular failure.

7. Anti platelet drugs ASPIRIN Clopidogrel Abciximab Dipyridamole

8. Contraindications: Should not be administered in case of: Asthma Renal impairment Dengue Fever Gout and Hyper uricemia Allergy to NSAIDs Uses: Besides Myocardial Infarction, also used in: Pain Headache Fever Inflammation Strokes

9. To Decrease myocardial oxygen consumption Beta Blockers Calcium Channel Blockers

10. Beta Blockers Atenolol Metaprolol E smolol

11. Contraindications: Should not be administered in case of: Hypersensitivity Sinus bradycardia Sinus Node Dysfunction Heart Block 1 st Degree Pregnancy Cardiogenic Shock Uses: Besides Myocardial Infarction, also used in: Hypertension Migraine Arrhythmia Angina Pectoris

12. Calcium channel blockers Amlodipine Nifedipine Nimodipine Mechanism Of Action:

13. Contraindications: Should not be administered in case of: Hypersensitivity to CCBs Severe Hypertension Caution when used in lactating and pregnant women Uses: Besides Myocardial Infarction, also used in: Angina pectoris Supraventricular arrhythmias Hypertension migraine

14. Anti- Hyperlipidemic agents Lovastatin Pitavastatin Fluvastatin Rosuvastatin

15. Angiotensin receptor blockers

16. Other Drugs Pain management is an important consideration because pain and associated anxiety stimulates sympathetic activity, which can be deleterious to the heart. Therefore, analgesic drugs such as Morphine (2-8 mg) is often given in the acute setting to reduce pain . Morphine also has other beneficial effects as a vasodilator as it triggers massive Histamine release. Antiarrhythmic drugs are administered particularly when their are serious ventricular rhythm disturbances. Diuretics may also be given depending on the degree of heart failure and fluid retention.

17. Drug Therapy for MI in a glimpse: Acute Myocardial Infarction: Goal of treatment Minimize damage Preserve function Prevent complications Morphine - treat pain Oxygen : treat tissue hypoxia NTG - SL, IV 24-48 hrs. titrated Aspirin - 324 mg orally Continuous ECG monitoring Beta Blockers : Given initially and continued after discharge. Long term therapy with beta blockers decrease incidence of future cardiac events Thrombolytic Streptokinase, Alteplase , Reteplase Break up thrombus, allows for reperfusion May still need cardiac catheterization done Doesn't do anything for underlying lesion but will hopefully break up the clot To be effective, give within 6 hours Best if given within 30 minutes of arriving to ER (door to drug time)