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HEART FACTS
 The average adult heart beats
 72 times a minute;
 100,000 times a day;
 3,600,000 times a year;
 and 2....
HEART FACTS
 Though weighing only 11 ounces on average,
 a healthy heart pumps
 2,000 gallons of blood through
 60,000...
HEART FACTS
 5% of blood supplies the heart,
 15-20% goes to the brain and central nervous system,
 and 22% goes to the...
ANGINA PECTORIS
 Is a pain syndrome due to an adverse
oxygen supply/demand situation in a
portion of myocardium
ANTIANGINAL DRUGS
DR. V.SATHYANARAYANAN M.D
PROFESSOR OF PHARMACOLOGY
SRM MCH & RC
CHENNAI, INDIA
TYPES OF ANGINA
Classical angina
common form
due to fixed coronary obstruction
Ischemic pain is felt
Subside when the ...
Variant angina
 Prinzmetal’s angina
 Attacks occur at rest or during sleep
 Unpredictable
 Due to localized coronary v...
Unstable angina

Rapid increase in duration and
severity of attacks
Due to rupture of an atheromatous plaque
 platelet...
HEART FACTS
 The human heart begins to beat as
early as
four weeks after conception
HEART FACTS
 Grab a tennis ball and squeeze it tightly:
 that’s how hard the beating heart works to pump blood.
 A woma...
HEART FACTS
Every day, the heart creates enough energy to
drive a truck 20 miles.
 In a lifetime, that is equivalent to...
HEART FACTS
 During an average lifetime,
 the heart will pump nearly 1.5 million gallons of blood—
 enough to fill 200 ...
ANTIANGINAL DRUGS
 Prevent, abort or terminate
attacks of angina pectoris
Do not alter the
course of coronary artery
pat...
CLASSIFICATION
1.NITRATES – SHORT ACTING –Glyceryl trinitrate
LONG ACTING – Isosorbide dinitrate, Isosorbide mononitrate
...
NITRATES- GLYCERYL TRINITRATE-
(PROTOTYPE)
 ACTIONS

1. PRELOAD REDUCTION
 Dilate veins
  peripheral pooling of blood...
ACTIONS
decrease afterload
Some arteriolar dilatation
 slightly decrease total peripheral resistance
decrease afterlo...
ACTIONS
Dilate larger coronary vessels

 increase blood flow to
ischemic areas
ACTIONS

Dilate cutaneous blood vessels  flushing

Dilate meningeal vessels  headache
 Shift blood from pulmonary cir...
ACTIONS
Relax bronchi
Relax biliary tract
Relax esophagus
MECHANISM OF ACTION
Denitrated in smooth muscle
 release Nitric Oxide
 activates cytosolic guanylyl cyclase
 increa...
PHARMACOKINETICS
Well absorbed from buccal mucosa, skin,
intestine
Lipid soluble
Undergo extensive 1st
pass metabolism
...
ADR
 Headache, fullness in head
 Flushing,
 weakness
 Palpitation,
 sweating,
 dizziness, fainting
 Methemoglobinem...
TOLERANCE
 Decreased effectiveness of nitrates on repeated
administration
 Seen with GTN used orally, i.v, transdermally...
DEPENDENCE
Seen after sudden withdrawal after
prolonged exposure
Myocardial infarction,
sudden deaths,
increase episod...
Sex and cardiovascular system
 CHANGES DURING ORGASM……
 Tachycardia  upto 180 beats/ minute
 BP  230/130 mmHg even in...
INTERACTIONS
Potentiation of action by
sildenafil  severe hypotension
 MI, deaths
With other vasodilators
 additive...
GLYCERYL TRINITRATE
Volatile liquid
Stored in tight glass container
Taken sublingually terminate an anginal
attack
Act...
DOCTOR….. DOCTOR…..
Patient: It's been one month since my last visit
and I still feel miserable.
Doctor: Did you follow ...
ISOSORBIDE DINITRATE
 Solid
 S/L – Slower acting than GTN
 Orally given for chronic prophylaxis
 High 1st pass effect
...
ISOSORBIDE MONO NITRATE
 Active metabolite of ISDN
Little 1st
pass effect  high BA
 Long acting
 SR tablet given once...
OTHER NITRATES
• Erythrityl tetranitrate,
Pentaerythritol tetranitrate
are longer acting
• Used for chronic prophylaxis
HEART FACTS
 When the body is at rest,
 it takes only 6 seconds for the blood
 to go from the heart to the lungs and ba...
USES
 Angina pectoris –effective in classical
angina, variant angina increase exercise tolerance,
given as “as and when ...
BETABLOCKERS IN ANGINA
Decrease cardiac work, oxygen consumption during
exercise, anxiety
All are Equally effective in p...
BETABLOCKERS IN ANGINA - CAUTION
Sudden withdrawal
precipitates angina, even MI
 beta-blockers are Contraindicated in
va...
SUMMARY
 Angina pectoris is a symptom of myocardial ischaemia
 Acute attack is treated with GTN 0.5mg sublingually
 Aff...
CALCIUM CHANNEL BLOCKERS
 Verapamil
 Nifedipine
 Diltiazem
PHARMACOLOGICAL ACTIONS
 Smooth muscle relaxation –
 arterioles, bronchi, biliary, intestinal, bladder,
uterine relaxati...
VERAPAMIL
 Decreases heart rate, A-V conduction,
dilates arterioles, decreases t.p.r
 ADR- nausea, constipation, bradyca...
DILTIAZEM
 Cause consistent fall in BP, dilate
coronaries
 Less potent vasodilator than nifedipine &
verapamil
 Modest ...
NIFEDIPINE
 Prototype of DHP
 Arteriolar dilatation  t.p.r decreases 
fall in BP
 ADR – palpitation, flushing, ankle ...
FELODIPINE
 Greater vascular selectivity
 Larger tissue distribution
 Long t ½
AMLODIPINE
 Slow oral absorption
 Devoid of vasodilator side effects like
flushing, palpitation, headache, postural
dizz...
NITRENDIPINE
 Release nitric oxide  additional
mechanism For vasodilatation
 Retard atherosclerosis
 Indicated in hype...
LACIDIPINE
 Highly vasoselective newer DHP
 Once daily dose
 Used only in hypertension
NIMODIPINE
 Short acting DHP
 Selectively relaxes cerebral blood vessels
 Used in treating neurological deficit due
to ...
USES OF CALCIUM CHANNEL
BLOCKERS
•
Can be safely given where beta blockers are
contraindicated ( COPD, PVD )
• Angina pect...
OTHER USES OF CALCIUM CHANNEL BLOCKERS
 Hypertrophic cardiomyopathy – verapamil
 Premature labour – nifedipine
 Migrain...
RATIONAL DRUG COMBINATIONS
• When mono therapy fails to give relief
• Beta blockers + long-acting nitrates –
• tachycardia...
POTASSIUM CHANNEL
OPENERS
 Minoxidil, diazoxide
 Nicorandil
 Pinacidil
 cromokalim
MECHANISM OF ACTION
 Activates ATP sensitive K+ Channels
  increase outflow of K+ ions
  hyperpolarisation
  decrea...
NICORANDIL
 Novel antianginal drug
 Cause arteriolar, venodilatation
 Increase coronary blood flow
 Beneficial effects...
Side effects
 headache,
 flushing,
 palpitation,
 dizziness,
 painful apthous ulcers
POTENTIAL CLINICAL
APPLICATIONS
 Angina pectoris when tolerance is a
problem, when others are
contraindicated
 Hyperten...
POTENTIAL CLINICAL
APPLICATIONS
 Bronchial asthma
 Peripheral vascular disease
 Premature labour
 Urinary urge inconti...
DIPYRIDAMOLE
 Powerful coronary dilator
 Can cause coronary steal phenomenon
 Inhibits platelet aggregation
 Not usefu...
TRIMETAZIDINE
 Novel antianginal drug
 Improve cellular tolerance to ischemia by
inhibiting LC3CAT
 Reduce anginal atta...
RANOLAZINE
 Trimetazidine congener
 Spares fatty acid oxidation and shifts ATP
production to more O2 efficient
carbohydr...
IVABRADINE
 Pure hear rate lowering antianginal drug
 Recently introduced as an alternative to betablockers
 Blocks car...
DRUGS FOR PERIPHERAL
VASCULAR DISEASES
 CYCLANDELATE
 XANTHINOL NICOTINATE
 PENTOXIPHYLLINE
 CILOSTAZOLE
 CCBs
 ALPH...
PENTOXIPHYLLINE
 Analogue of theophylline
 Weak PDE inhibitor
 Increases blood flow in ischemic areas by
reducing whole...
CILOSTAZOLE
 PDE-3 inhibitor
 Increases cyclic AMP  vasodilatation, antiplatelet
aggregating activity
 More effective ...
MYOCARDIAL INFARCTION
 Ischaemic necrosis of a portion of the
myocardium due to sudden occlusion of a
branch of coronary ...
DRUG THERAPY OF
MYOCARDIAL INFARCTION
 Parenteral
Morphine/pethidine,
 diazepam for pain, anxiety,
fear
 Oxygenation
 ...
DRUG THERAPY OF MYOCARDIAL INFARCTION
• Low dose aspirin for the
prevention of thrombi
extension
• Heparin/oral anticoagul...
DRUG THERAPY OF
MYOCARDIAL INFARCTION
 GTN i.v/nitroprusside for vasodilatation
 Frusemide I.V if pulmonary edema presen...
DRUG THERAPY OF
MYOCARDIAL INFARCTION
• Sodium bicarbonate i.v to correct acidosis
• Slow i.v infusion of saline/LMW dextr...
PREVENTION OF FUTURE
ATTACKS
 Aspirin low dose/clopidogrel given on
long-term basis
 Betablockers to reduce
 risk of re...
Any intelligent fool can make things
bigger, more complex, and more violent.
It takes a touch of genius -- and a lot of
co...
THANK YOU
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Antianginal drugs satya

An interesting ppt on antianginal drugs and drug therapy of myocardial infarction with illustrations for better understanding of concepts and grasping facts...

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Antianginal drugs satya

  1. 1. HEART FACTS  The average adult heart beats  72 times a minute;  100,000 times a day;  3,600,000 times a year;  and 2.5 billion times during a lifetime.
  2. 2. HEART FACTS  Though weighing only 11 ounces on average,  a healthy heart pumps  2,000 gallons of blood through  60,000 miles of blood vessels  each day.
  3. 3. HEART FACTS  5% of blood supplies the heart,  15-20% goes to the brain and central nervous system,  and 22% goes to the kidneys.
  4. 4. ANGINA PECTORIS  Is a pain syndrome due to an adverse oxygen supply/demand situation in a portion of myocardium
  5. 5. ANTIANGINAL DRUGS DR. V.SATHYANARAYANAN M.D PROFESSOR OF PHARMACOLOGY SRM MCH & RC CHENNAI, INDIA
  6. 6. TYPES OF ANGINA Classical angina common form due to fixed coronary obstruction Ischemic pain is felt Subside when the increased energy demand is withdrawn attacks are provoked by  exercise, emotion,  eating or coitus
  7. 7. Variant angina  Prinzmetal’s angina  Attacks occur at rest or during sleep  Unpredictable  Due to localized coronary vasospasm
  8. 8. Unstable angina  Rapid increase in duration and severity of attacks Due to rupture of an atheromatous plaque  platelet deposition  progressive occlusion of coronary artery
  9. 9. HEART FACTS  The human heart begins to beat as early as four weeks after conception
  10. 10. HEART FACTS  Grab a tennis ball and squeeze it tightly:  that’s how hard the beating heart works to pump blood.  A woman’s heart typically beats faster than a man’s.
  11. 11. HEART FACTS Every day, the heart creates enough energy to drive a truck 20 miles.  In a lifetime, that is equivalent to driving to the moon and back.
  12. 12. HEART FACTS  During an average lifetime,  the heart will pump nearly 1.5 million gallons of blood—  enough to fill 200 train tank cars.
  13. 13. ANTIANGINAL DRUGS  Prevent, abort or terminate attacks of angina pectoris Do not alter the course of coronary artery pathology
  14. 14. CLASSIFICATION 1.NITRATES – SHORT ACTING –Glyceryl trinitrate LONG ACTING – Isosorbide dinitrate, Isosorbide mononitrate 2.BETABLOCKERS – Propranolol, metoprolol, Atenolol 3.CALCIUM CHANNEL BLOCKERS – Verapamil, Diltiazem, Nifedipine, Amlodipine, Nitrendipine 4.POTASSIUM CHANNEL OPENER – Nicorandil 5.OTHERS – Trimetazidine, Dipyridamole, Oxyfedrine
  15. 15. NITRATES- GLYCERYL TRINITRATE- (PROTOTYPE)  ACTIONS  1. PRELOAD REDUCTION  Dilate veins   peripheral pooling of blood   decrease venous return   decrease preload   decrease cardiac work according to Laplace relationship   decrease oxygen consumption, decrease in the cardiac output
  16. 16. ACTIONS decrease afterload Some arteriolar dilatation  slightly decrease total peripheral resistance decrease afterload  decrease in cardiac work
  17. 17. ACTIONS Dilate larger coronary vessels   increase blood flow to ischemic areas
  18. 18. ACTIONS  Dilate cutaneous blood vessels  flushing  Dilate meningeal vessels  headache  Shift blood from pulmonary circuit to systemic circuit  decongest lungs
  19. 19. ACTIONS Relax bronchi Relax biliary tract Relax esophagus
  20. 20. MECHANISM OF ACTION Denitrated in smooth muscle  release Nitric Oxide  activates cytosolic guanylyl cyclase  increase cGMP  dephosphorylation of MLCK  reduced availability of active MLCK interferes with the activation of Myosin   fails to interact with actin  relaxation  cGMP  decrease ca entry  relaxation
  21. 21. PHARMACOKINETICS Well absorbed from buccal mucosa, skin, intestine Lipid soluble Undergo extensive 1st pass metabolism except isosorbide mononitrate Rapidly denitrated  produce less active metabolites with longer t1/2
  22. 22. ADR  Headache, fullness in head  Flushing,  weakness  Palpitation,  sweating,  dizziness, fainting  Methemoglobinemia – a problem in severe anemia  Rashes – particularly with pentaerythritol tetranitrate
  23. 23. TOLERANCE  Decreased effectiveness of nitrates on repeated administration  Seen with GTN used orally, i.v, transdermally  With long acting agents  Cross tolerance also seen  Prevented by keeping nitrate free interval everyday
  24. 24. DEPENDENCE Seen after sudden withdrawal after prolonged exposure Myocardial infarction, sudden deaths, increase episodes of angina on record Add a drug of another class Withdrawal must be gradual
  25. 25. Sex and cardiovascular system  CHANGES DURING ORGASM……  Tachycardia  upto 180 beats/ minute  BP  230/130 mmHg even in normotensives  ECG abnormalities may occur  RESPIRATORY RATE  60 / min  SUDDEN DEATHS  CAUTION – older patients with CAD
  26. 26. INTERACTIONS Potentiation of action by sildenafil  severe hypotension  MI, deaths With other vasodilators  additive hypotension
  27. 27. GLYCERYL TRINITRATE Volatile liquid Stored in tight glass container Taken sublingually terminate an anginal attack Acts within 1-2 minutes Also administered as sublingual spray, S.R. capsule, transdermal patch, i.v infusion, transmucosal dosage form Given as i.v infusion in unstable angina, LVF in MI, during cardiac surgeries
  28. 28. DOCTOR….. DOCTOR….. Patient: It's been one month since my last visit and I still feel miserable. Doctor: Did you follow the instructions on the medicine I gave you? Patient: I sure did - the bottle said 'keep tightly closed.'
  29. 29. ISOSORBIDE DINITRATE  Solid  S/L – Slower acting than GTN  Orally given for chronic prophylaxis  High 1st pass effect  t1/2 - 4O min  Leave 6-10 hr nitrate free interval
  30. 30. ISOSORBIDE MONO NITRATE  Active metabolite of ISDN Little 1st pass effect  high BA  Long acting  SR tablet given once daily in morning
  31. 31. OTHER NITRATES • Erythrityl tetranitrate, Pentaerythritol tetranitrate are longer acting • Used for chronic prophylaxis
  32. 32. HEART FACTS  When the body is at rest,  it takes only 6 seconds for the blood  to go from the heart to the lungs and back,  only 8 seconds for it  to go the brain and back, and  only 16 seconds for it  to reach the toes and travel all the way back to the heart.
  33. 33. USES  Angina pectoris –effective in classical angina, variant angina increase exercise tolerance, given as “as and when required” basis  Acute coronary syndromes  Congestive heart failure  Acute left ventricular failure  Myocardial infarction – of marginal benefit  Interventional cardiac procedures  Biliary colic  Esophageal spasm  Cyanide poisoning  Venipuncture
  34. 34. BETABLOCKERS IN ANGINA Decrease cardiac work, oxygen consumption during exercise, anxiety All are Equally effective in preventing angina Cardio selective beta blockers are preferred To be taken on regular schedule Dosage to be individualized Tolerance does not develop DO NOT DILATE CORONARY VESSELS
  35. 35. BETABLOCKERS IN ANGINA - CAUTION Sudden withdrawal precipitates angina, even MI  beta-blockers are Contraindicated in variant angina
  36. 36. SUMMARY  Angina pectoris is a symptom of myocardial ischaemia  Acute attack is treated with GTN 0.5mg sublingually  Affords only symptomatic relief  Nitrates act by reducing pre-load, afterload, dilates coronary arteries  Cause headache, flushing, palpitation as side effects  Betablockers are useful in the prophylaxis  Withdrawal of these drugs must be gradual  Sildenafil usage during nitrates therapy may be fatal
  37. 37. CALCIUM CHANNEL BLOCKERS  Verapamil  Nifedipine  Diltiazem
  38. 38. PHARMACOLOGICAL ACTIONS  Smooth muscle relaxation –  arterioles, bronchi, biliary, intestinal, bladder, uterine relaxation-  Marked with DHP group ( nifedipine)  Heart –  negative inotropic, chronotropic, dromotropic action –  marked with verapamil, lesser extent with diltiazem, not with DHP group
  39. 39. VERAPAMIL  Decreases heart rate, A-V conduction, dilates arterioles, decreases t.p.r  ADR- nausea, constipation, bradycardia  C/I – A-V block, CHF  D/I – Should not be given with betablockers, quinidine, increases digoxin level
  40. 40. DILTIAZEM  Cause consistent fall in BP, dilate coronaries  Less potent vasodilator than nifedipine & verapamil  Modest negative inotropic action  ADR – similar as verapamil
  41. 41. NIFEDIPINE  Prototype of DHP  Arteriolar dilatation  t.p.r decreases  fall in BP  ADR – palpitation, flushing, ankle edema, hypotension, headache  ADR can be minimized by low starting dose, using retard formulation
  42. 42. FELODIPINE  Greater vascular selectivity  Larger tissue distribution  Long t ½
  43. 43. AMLODIPINE  Slow oral absorption  Devoid of vasodilator side effects like flushing, palpitation, headache, postural dizziness  Long t1/2  Diurnal fluctuation is small  Action extends over next morning
  44. 44. NITRENDIPINE  Release nitric oxide  additional mechanism For vasodilatation  Retard atherosclerosis  Indicated in hypertension, angina pectoris
  45. 45. LACIDIPINE  Highly vasoselective newer DHP  Once daily dose  Used only in hypertension
  46. 46. NIMODIPINE  Short acting DHP  Selectively relaxes cerebral blood vessels  Used in treating neurological deficit due to cerebral vasospasm following subarachnoid hemorrhage
  47. 47. USES OF CALCIUM CHANNEL BLOCKERS • Can be safely given where beta blockers are contraindicated ( COPD, PVD ) • Angina pectoris – in both classical angina & variant angina • reduce afterload, long acting DHP are preferred • Myocardial Infarction - verapamil/diltiazem given in secondary prophylaxis where beta blockers are contraindicated • Hypertension • Cardiac arrhythmias
  48. 48. OTHER USES OF CALCIUM CHANNEL BLOCKERS  Hypertrophic cardiomyopathy – verapamil  Premature labour – nifedipine  Migraine – verapamil  Raynaud’s phenomenon – DHP’s  Nocturnal leg cramps
  49. 49. RATIONAL DRUG COMBINATIONS • When mono therapy fails to give relief • Beta blockers + long-acting nitrates – • tachycardia due to nitrates is blocked, • ventricular dilatation, reduced coronary blood flow due to B –blocker is blocked • Slow acting DHP Ca channel blocker + B-blocker • Nitrates + CCB  Valuable in severe vasospastic angina • Nitrates + B-blocker + CCB in resistant cases • (VERAPAMIL/DILTIAZEM should be avoided in such combinations)
  50. 50. POTASSIUM CHANNEL OPENERS  Minoxidil, diazoxide  Nicorandil  Pinacidil  cromokalim
  51. 51. MECHANISM OF ACTION  Activates ATP sensitive K+ Channels   increase outflow of K+ ions   hyperpolarisation   decrease Ca++ entry   smooth muscle relaxation
  52. 52. NICORANDIL  Novel antianginal drug  Cause arteriolar, venodilatation  Increase coronary blood flow  Beneficial effects similar to nitrates, CCB’s, B-blockers  Decrease myocardial stunning, infarct size, arrhythmias in MI  Dose – 5-20 mg bd
  53. 53. Side effects  headache,  flushing,  palpitation,  dizziness,  painful apthous ulcers
  54. 54. POTENTIAL CLINICAL APPLICATIONS  Angina pectoris when tolerance is a problem, when others are contraindicated  Hypertension  CHF  Myocardial salvage in MI
  55. 55. POTENTIAL CLINICAL APPLICATIONS  Bronchial asthma  Peripheral vascular disease  Premature labour  Urinary urge incontinence  Penile erection disorder
  56. 56. DIPYRIDAMOLE  Powerful coronary dilator  Can cause coronary steal phenomenon  Inhibits platelet aggregation  Not useful as an antianginal drug  Used in the prophylaxis in post MI, post stroke to prevent thrombosis
  57. 57. TRIMETAZIDINE  Novel antianginal drug  Improve cellular tolerance to ischemia by inhibiting LC3CAT  Reduce anginal attacks in patients not responding to other drugs  ADR- gastric burning, dizziness, fatigue, parkinsonism  Useful as an add on medication to conventional therapy in angina, post MI
  58. 58. RANOLAZINE  Trimetazidine congener  Spares fatty acid oxidation and shifts ATP production to more O2 efficient carbohydrate oxidation  Torsades de pointes is a risk  Recommended only in combination
  59. 59. IVABRADINE  Pure hear rate lowering antianginal drug  Recently introduced as an alternative to betablockers  Blocks cardiac pacemaker cell “f” channels  decreases heart rate  decreases oxygen demand,  prolongs diastole  improves myocardial blood flow  increased oxygen supply  ADR  VISUAL DISTURBANCES, headache, dizziness, nausea  USES  chronic stable angina pectoris alternate to betablockers, inappropriate sinus tachycardia
  60. 60. DRUGS FOR PERIPHERAL VASCULAR DISEASES  CYCLANDELATE  XANTHINOL NICOTINATE  PENTOXIPHYLLINE  CILOSTAZOLE  CCBs  ALPHABLOCKERS  PGI2  severe cases with rest pain
  61. 61. PENTOXIPHYLLINE  Analogue of theophylline  Weak PDE inhibitor  Increases blood flow in ischemic areas by reducing whole blood viscosity,  And by improving flexibility of RBCs  ADR  nausea, vomiting, dyspepsia, bloating  USES  intermittent claudication, Trophic leg ulcers, TIAs
  62. 62. CILOSTAZOLE  PDE-3 inhibitor  Increases cyclic AMP  vasodilatation, antiplatelet aggregating activity  More effective than pentoxiphylline for claudication pain  Not to be used in heart failure  ADR  HEADACHE, nausea, dizziness, palpitation, weakness  USES  intermittent claudication with no rest pain or heart failure
  63. 63. MYOCARDIAL INFARCTION  Ischaemic necrosis of a portion of the myocardium due to sudden occlusion of a branch of coronary artery  Acute thrombus is the cause  25% die before therapy  Has to be treated in I.C.C.U’S
  64. 64. DRUG THERAPY OF MYOCARDIAL INFARCTION  Parenteral Morphine/pethidine,  diazepam for pain, anxiety, fear  Oxygenation  Streptokinase/ urokinase/ alteplase for thrombolysis
  65. 65. DRUG THERAPY OF MYOCARDIAL INFARCTION • Low dose aspirin for the prevention of thrombi extension • Heparin/oral anticoagulants to prevent DVT • Dopamine/ dobutamine for increasing pumping action of heart
  66. 66. DRUG THERAPY OF MYOCARDIAL INFARCTION  GTN i.v/nitroprusside for vasodilatation  Frusemide I.V if pulmonary edema present  i.v beta blocker to prevent arrhythmias  Lidocaine/procainamide for tachyarrhythmias  Atropine for heart block
  67. 67. DRUG THERAPY OF MYOCARDIAL INFARCTION • Sodium bicarbonate i.v to correct acidosis • Slow i.v infusion of saline/LMW dextran • to maintain blood volume, • tissue perfusion, • Microcirculation • ACE inhibitors/ARB’s to prevent remodeling, CHF
  68. 68. PREVENTION OF FUTURE ATTACKS  Aspirin low dose/clopidogrel given on long-term basis  Betablockers to reduce  risk of reinfarction,  CHF,  death  Statins to control hyperlipidaemias
  69. 69. Any intelligent fool can make things bigger, more complex, and more violent. It takes a touch of genius -- and a lot of courage -- to move in the opposite direction." Albert Einstein
  70. 70. THANK YOU

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