PHARMACOTHERAPY OF MYOCARDIAL INFARCTION.pptx

PHARMACOTHERAPY OF MYOCARDIAL INFARCTION.pptx

1. PHARMACOTHERAPY OF MYOCARDIAL INFARCTION Dr.S.R.Akshaya navena

2. Rupture or erosion of local atherosclerotic plaque leading to thrombus formation. Silent infarct or cardiogenic shock. Classified to STEMI – total occlusion by thrombus NSTEMI –partial occlusion by thrombus

3. MANAGEMENT OF MI RELIEF OF PAIN: Bradycardia – Pethidine hydrochloride (25-50mg). Buprenorphine 0.4mg s.c or 0.3-0.6mg i.m 6-8 hourly. OXYGEN AND REST: 100% oxygen through face mask.

4. THROMBOLYTIC THERAPHY :

5. ANTIPLATELET THERAPY: Aspirin (100-300MHG)/ Clopidogrel MAINTANENCE OF EFFECTIVE BLOOD VOLUME: Elevating lower limbs,5% dextrose. CORRECTION OF ACIDOSIS: Sodium bicarbonate infusion. INOTROPIC DRUGS: Dopamine , Dobutamine – arrhythmias , tachycardia.

6. PREVENTION AND TREATMENT OF ARRHYTHMIAS: Prophylactic administration of i.v /oral Beta blocker causes myocardial salvage. Tachyarrhythmais treated with i.v lidocaine,procainamide,amiodarone . Bradycardia managed by atropine or electrical pacing.

7. BETA BLOCKERS: Given within 4-6hr. Contraindications: Bronchospasm,resting bardycardia (less than 55/min) Low systolic BP(<95mmhg) and heart block. ACEI: Given within 24 hr. Contraindications: Hypotension,bilateral renal artery stenosis,renal failure,history of intolerance.

8. ANTICOAGULANTS: STEMI,NSTEMI Prevents venous thrombosis,pulmonary embolism,stroke in patients with severe LV dysfunction. LMWH – s.c 3-5days. GENERAL MEASURES: Benzodiazepines,soft low calorie diet,use of stool softeners,life style modifications.

9. Life long continuation of low dose of Aspirin (75-100mg)-reduce reinfarction . Beta adrenergic blockers: Atenlol,50-100mg od/ Metoprolol 100mg BD fgor 2-3 years. ACE INHIBITORS: Continued in patients with LV dysfunction and in patients with DM. 00 Control of hyperlipidaemia : Dietary substituition with unsaturated fatty acids,statins .