MI pharm Flashcards
initial tm
O2, morphine, aspirin, nitro, BB if not CI, thrombolytic if eligible
oxygen
increase O2 delivery to ischemic myocardium
bc supply and demand issue
morphine
decrease pain and stress, dilate BV
SE = resp dep and hypoT
decrease preload and afterload
help preserve ischemic tissue
aspirin
chew
make plt less sticky - suppress plt aggregation
decrease mortality
nitro
SL or IV
dilate veins and arteries, decrease preload and afterload
tolerate? -> check BP
limit infarct size but does not reduce mortality
BB
HR? BP? -> CI
beta 1 selective (2 = lungs)
reduce pain, infarct size, and mortality
reduce HR and contractility (decrease O2 demand)
thrombolytic
CI: recurrent hemorrhagic stroke, brain bleed
high r/o bleed
ideally w/n 4-6hr of chest pain to be effective
fibrinolytic therapy
if cath lab not avail -> PCI is 1st choice
tPA
tPA
alteplase
moa: dissolve clot by converting plasminogen into plasmin which dissolves clot
most effective
best w/n 30 - 70 min of s/s onset
SE: bleed, CI with hx brain bleed
always give with heparin and anti plt (clopidogrel) -> prevent new clots
nitroglycerin
vasodilate
SE: hypoT, HA, flush
severe hypoT esp with other nitrates -> no sildenafil
interventions for reperfussion
angioplasty and atherectomy
angioplasty and stent placement
coronary artery bypass graft (CABG)
reperfussion injury
rapid restoration of BF to myocardium also contributes to injury bc myocardial stunning -> can cause HF
caused by oxidized free radicals generated by wbc (responding to damaged tissue) and cellular response to restored BF
reperfussion dysR -> v tachy, v fib
facts
hesitancy and delayed response lead to death
survival 90-95%
1/2 <65
DM and those >65 can suffer silent and asymp MI
post MI drug therapy
aspirin: inhibit plt aggregation
BB: reduce HR and BP, lower r/o death when continued long term after MI
ACEi: stimulation dilation of BV by inhibiting angiotensin 2, improve remodeling after MI
statin: address CV disease
