Here's a Presentation made by me on Drugs Used for Myocardial Infraction. This slide was created for Problem Based Learning (PBL) wrap up session Held At Kathmandu University- Birat Medical College Teaching Hospital (BMCTH). feel free to Download and share this slide. You can leave comments so that i may improve on other presentations. Thankyou. Cheers!

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

7. 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.

8. Anti platelet drugs
ASPIRIN
Clopidogrel
Abciximab
Dipyridamole

9. 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

10. To Decrease myocardial oxygen consumption
•Beta Blockers
•Calcium Channel Blockers

11. Beta Blockers
Atenolol
Metaprolol
Esmolol

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

13. Calcium channel blockers
Amlodipine
Nifedipine
Nimodipine
Mechanism Of Action:

14. 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

15. Anti-Hyperlipidemic agents
Lovastatin
Pitavastatin
Fluvastatin
Rosuvastatin

16. Angiotensin receptor blockers

17. 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.

18. 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)