General pharmacologic treatment of acute myocardial infarction.
The general pharmacotherapeutic issues surrounding AMI are complex and expanding, especially with regard to treatment aimed at the [table: see text] culprit, coronary atherosclerotic thrombus. Basic, well-established therapy includes the routine administration of oxygen, nitroglycerin, aspirin, and at times morphine, with selected cases invoking caution with respect to these agents (e.g., nitroglycerin and the risk of hypotension in right ventricular infarction; contraindication to nitrolycerin in patients on sildenafil). Cardioprotective agents, especially beta-adrenergic antagonists, should be considered early in light of their demonstrated benefit; others, such as ACE inhibitors, need not be administered in the ED. Heparin, both UFH and the newer LMWHs, have well-established roles in acute coronary syndromes. The GP IIb/IIIa inhibitors are the most recent addition to the pharmacologic armamentarium; their role is evolving rapidly as research on this frontier continues. Table 2 reviews recommended dosing of selected agents in acute coronary syndromes.
Shannon
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AW
Division of Emergency Medicine, Department of Medicine, Temple University Hospital and School of Medicine, Philadelphia, Pennsylvania, USA.
Harrigan
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RA
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002637:Chest Pain / Q000188:drug therapy; D004636:Emergency Service, Hospital; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008274:Magnesium / Q000627:therapeutic use; D008562:Membrane Glycoproteins / Q000037:antagonists & inhibitors; D009020:Morphine / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000473:pathology; D009294:Narcotics / Q000627:therapeutic use*; D009566:Nitrates / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D008562:Membrane Glycoproteins; D009294:Narcotics; D009566:Nitrates; D010975:Platelet Aggregation Inhibitors; D009020:Morphine; D006493:Heparin; D008274:Magnesium