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2.drugsusedforthetreatmentofmi 121112230936 Phpapp02
2.drugsusedforthetreatmentofmi 121112230936 Phpapp02
myocardial ischemia
Presented by
Sk.yasmeen I/II M.Pharmacy
Department of pharmacology
Hindu college of pharmacy
Guntur
Stable MI
It is a most common type
Occurs when heart is working harder than usual
Regular pattern to this condition
After several episodes, patient learns to recognize &predict
Pain goes away in a few min by taking rest & medicine
variant MI
• It is rare and occurs at rest
• Pain associated with this can be severe and usually
occurs between midnight and early morning
• Pain relieved by medicines
unstable MI
• it is dangerous condition & requires emergency
treatment
• it is a sign that heart attack could occur soon
• it does not follow a pattern
• occurs without physical exertion & not relieved by rest
& medicine
Conditions that increases o2 supply
1. Stress
2. Exercise
3. During increased heart rate
Conditions that decrease o2 supply
1. Coronary arteries diseases
Accumulation of plaques
Platelets aggregation
Stenosis or spasm or constriction or narrowing
2. Reduction in blood flow to heart
Due to constriction of blood vessels
3. Reduction in o2carrying capacity of blood
Decrease Hb levels (in anemic conditions)
Normal blood flow and supply but decrease in o2 carrying
capacity
Symptoms
Some people have “silent ischemia”
MI with sign & symptoms include
1. Chest pain (left side)
2. Neck or jaw pain
3. Shoulder or arm pain
4. Clammy skin
5. Nausea &vomiting
Causes
1. Coronary artery diseases
2. Blood clot
3. Coronary spasm
4. Sever illness
Risk factors
1. Tobacco
2. Diabetis
3. High B.P
4. High blood cholesterol or triglyceride levels
5. Lack of physical activity
6. Obesity
7. Family history
Complications
Irregular heart rhythms (arrhythmia)
Heart attack (myocardial infarction)
Classification
coronary vasodilators
1. Nitrites & nitrates
according to duration of action
Shot acting (3 to 60 min)
Amyl nitrite, nitroglycerin(sublingual), isosorbide
dinitrate
Intermediate acting(3 to 6hrs)
Isosorbide dinitrate ,nitroglycerin(ointment)
Long acting(6 to 10 hrs)
Erythirtyl tetranitrate, nitroglycerin (trans-cutaneous
Beta adrenergic blocking agents
Atenolol
Propranolol
Nadolol
Side effects
•Swelling of legs
•Excess lowering of heart rate and blood pressure
•Depressing heart muscle function
β-Blockers
These decrease O2 demands by lowering the heart rate &
contractility (decrease CO) particularly the increased
demand associated with exercise.
They also reduce PVR by direct vasodilation of both
arterial & venous vessels reducing both pre- and after load.
These effects are caused by blocking β1 receptors, selective
β1 antagonists
o atenolol,
o metoprolol and
o acebutolol
lose their selectivity at high doses and at least partially
block β2 receptors (a concern for bronchospastic disease).
β1 antagonists reduce the frequency and severity of anginal
episodes particularly when used in combination with
nitrates.
β-Blockers
• There are a number of contraindications for β blockers:
asthma, diabetes, bradycardia.
Pharmacokinetics:
• GI
• 30-50% metabolized in the first-pass in liver.
• T1/2: 3-5 hours,
Side effects
•Worsening of asthma
•Depression, fatigue
•Impotence
•Increased cholesterol levels
•Shortness of breath due to diminished heart muscle function
Potassium channel opener’s mechanism
Potassium channel openers
Leads to vasodilatation
Nicorandil
•Administration : orally
•Bioavailability : 75 to 80%
•Protein binding : 25%
•Metabolism : hepatic
•Half life : 1hr
•Excretion : renal Adverse effect
•Headaches
•Nausea
•Vasodilatation
•Vomiting
•Decrease B.P
•Stomach pain
Antiplatelet drugs
Mechanism of action
• prostacyclin (PGI2) & thromboxane (TXA2) are derived from archedonic
acid.
•PGI2 is formed from vascular endothelium
•TXA2 is generated by platelets is a vasoconstrictor
•PGI2 is important for natural resistance to arterial thrombosis
•TXA2 and vascular PGI2regulates the the platelet aggreability
•Collagen form sub endothelial matrix of damaged vessel initiates the
attachment
•TXA2 inhibits the adenylyl cyclase and lowers the cAMP concentration
•Low concentration of cAMP accelerates platelets aggregation
-Aspirin inhibits cyclo-oxygenase
•Adverse effects
•Nausea
•Rashes and diarrohea
•Peptic ulceration
Angiotensin converting enzyme inhibitors
Mechanism:
inhibit ACE
decreased PVR
Pharmacokinetics
Bioavailability : 60% (oral)
Metabolism : hepatic
Half life : 11 hrs
Excretion : renal
Main effects: decreased PVR decreased BP
Adverse effects: skin rash, taste, cough, hyperkalemia
Cholesterol lowering drugs
Mechanism of action
•Competitively inhibiting HMG-CoA reductase first
enzyme of HMG-CoA reductase pathway
•Statins are similar to HMG-CoA
•They take the place of HMG-CoA in the enzyme
and reduce the rate by which it is able to produce
mevalonate which is used in production of
cholesterol