Download Classes of Drugs Used to Treat Myocardial Infarction

Classes of Drugs Used to Treat Myocardial Infarction
Classes of drugs used in the treatment of myocardial infarction are given below. Clicking on the drug class will
link you to the page describing the pharmacology of that drug class.
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Vasodilators (dilate arteries and veins)
- nitrodilators
o isosorbide dinitrate
o isosorbide mononitrate
o nitroglycerin
o erythrityl tetranitrate
o pentaerythritol tetranitrate
o sodium nitroprusside
- angiotensin converting enzyme inhibitors (ACE inhibitors) (to treat hypertension & heart failure)
o
o
o
o
o
o
o
o
benazepril
captopril
enalapril
fosinopril
lisinopril
moexipril
quinapril
ramipril
- angiotensin receptor blockers (ARBs)

o
These drugs have very similar effects to angiotensin converting enzyme (ACE) inhibitors and are used for
the same indications (hypertension, heart failure, post- myocardial infarction).
o
o
o
o
o
o
o
candesartan
eprosartan
irbesartan
losartan
olmesartan
telmisartan
valsartan
Cardiac depressant drugs (reduce heart rate and contractility)
o Cardioinhibitory drugs depress cardiac function by decreasing heart rate (chronotropy) and
myocardial contractility (inotropy), which decreases cardiac output and arterial pressure. These
cardiac changes reduce the work of the heart and myocardial oxygen consumption. The
mechanisms of action of these drugs also lead to depressed electrical conduction (dromotropy)
within the heart. Some of these drugs may also impair relaxation (lusitropy).
o The mechanical and metabolic effects of these drugs make them very suitable for treating
hypertension, angina caused by coronary artery disease, and myocardial infarction. Furthermore,
their effects on electrical activity make them good candidates for the treatment of cardiac
Page 2, Classes of Drugs Used to Treat Myocardial Infarction
arrhythmias. Finally, some cardioinhibitors, notably certain beta-blockers, are used in the treatment
of heart failure.
- beta-blockers
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Clinical Uses
HTN Angina Arrhy MI CHF Comments
Class/Drug
Non-selective
β1/β2
carteolol
carvedilol
labetalol
nadolol
penbutolol
pindolol
propranolol
sotalol
timolol
β1-selective
acebutolol
atenolol
betaxolol
bisoprolol
esmolol
metoprolol
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
ISA
X
MSA
X X
X
nebivolol
ISA; long acting; also used for glaucoma
α-blocking activity
ISA; α-blocking activity
long acting
ISA
ISA; MSA
MSA; prototypical beta-blocker
several other significant mechanisms
primarily used for glaucoma
ultra short acting; intra or postoperative HTN
MSA
relatively selective in most patients; vasodilating (NO
release)
Abbreviations: HTN, hypertension; Arrhy, arrhythmias; MI, myocardial infarction; CHF, congestive heart
failure; ISA, intrinsic sympathomimetic activity.
- calcium channel blockers
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amlodipine
felodipine
isradipine
nicardipine
nifedipine
nimodipine
nitrendipine
Page 3, Classes of Drugs Used to Treat Myocardial Infarction
- centrally-acting sympatholytics
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clonidine
guanabenz
guanfacine
α-methyldopa
Antiarrhythmics (if necessary)
Antiarrhythmic drug classes:

Class I – Sodium-channel blockers

Class IA: atrial fibrillation, flutter; supraventricular & ventricular tachyarrhythmias
cinchonism (blurred vision, tinnitus, headache, psychosis);
anticholinergic (moderate)
quinidine*
cramping and nausea; enhances digitalis toxicity
anticholinergic (weak);
lupus-like syndrome in 25-30% of patients
procainamide
relatively short half-life
negative inotropic effect
disopryamide anticholinergic (strong)
Class IB: ventricular tachyarrhythmias (VT)
IV only; VT and PVCs
good efficacy in ischemic myocardium
lidocaine*
orally active lidocaine analog can cause pulmonary fibrosis
tocainide
orally active lidocaine analog good efficacy in ischemic myocardium
mexiletine
Class IC: life-threatening supraventricular tachyarrhythmias (SVT) and ventricular tachyarrhythmias
(VT)
SVT
can induce life-threatening VT
flecainide*
β-blocking and Ca++-channel blocking activity can worsen
propafenone SVT & VT;
heart failure
VT; IB activity
moricizine
* prototypical drug
Abbreviations: IV, intravenous; PVC, premature ventricular complex.
Page 4, Classes of Drugs Used to Treat Myocardial Infarction


Class II – Beta-blockers (see chart above)
Class III – Potassium-channel blockers
Drug
Therapeutic Uses
ventricular tachycardia,
includuing ventricular
amiodarone
fibrillation; atrial fibrillation
and flutter (off-label use)
Comments
very long half-life (25-60 days); Class I, II, III & IV actions and
therefore decreases phase 4 slope and conduction velocity;
potentially serious side effects (e.g., pulmonary fibrosis;
hypothyroidism)
structurally related to amiodarone, but has a much smaller volume
of distribution and shorter elimination half-life (13-19 hr); Class I,
II, III & IV actions; containdicated in severe or recently
decompensated, symptomatic heart failure; based on results from
atrial fibrillation (nondronedarone
the PALLAS trial in 2011, the FDA has concluded there are
permanent) and flutter
concerns regarding increased risk for severe liver injury and serious
cardiovascular adverse events in patients with permanent atrial
fibrillation, and therefore, this drug should be used only in patients
in sinus rhythm with a history of non-permanent atrial fibrillation
life-threatening ventricular IV only; initial sympathomimetic effect (norepinephrine release)
bretylium
tachycardia and fibrillation followed by inhibition, which can lead to hypotension
ventricular tachycardia;
sotalol
also has Class II activity
atrial flutter and fibrillation
slow inward Na+ activator, which delays repolarization; –inhibits
ibutilide
atrial flutter and fibrillation Na+-channel inactivation, which increases ERP; IV only; can cause
life-threatening ventricular arrhythmias
very selective K+-channel blocker; can cause life-threatening
dofetilide
atrial flutter and fibrillation
ventricular arrhythmias

Class IV – Calcium-channel blockers
Dihydropyridines include the following specific drugs: (Go to www.rxlist.com for specific
drug information)
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amlodipine
felodipine
isradipine
nicardipine
nifedipine
nimodipine
nitrendipine
Page 5, Classes of Drugs Used to Treat Myocardial Infarction
Non-dihydropyridines, of which there are only two currently used clinically, comprise the other
two classes of CCBs.
Verapamil (phenylalkylamine class), is relatively selective for the myocardium, and is
less effective as a systemic vasodilator drug. This drug has a very important role in
treating angina (by reducing myocardial oxygen demand and reversing coronary
vasospasm) and arrhythmias.
Diltiazem (benzothiazepine class) is intermediate between verapamil and
dihydropyridines in its selectivity for vascular calcium channels. By having both cardiac
depressant and vasodilator actions, diltiazem is able to reduce arterial pressure without
producing the same degree of reflex cardiac stimulation caused by dihydropyridines.

Miscellaneous –
 Adenosine
 Electrolytes (magnesium and potassium salts)
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hypomagnesemia (serum concentration <1.5 mg/dl) and hypokalemia (serum
concentration <3.5 mg/dl; severe hypokalemia, <2.5 mg/dl) can precipitate
cardiac arrhythmias, which include ventricular tachycardia and fibrillation,
premature ventricular complexes, supraventricular tachycardias (e.g., WolffParkinson-White Syndrome), atrial tachycardias, including flutter and fibrillation,
and arrhythmias associated with digitalis toxicity. For treating hypomagnesemiaassociated arrhythmias, magnesium sulfate may by administered intravenously.
Oral magnesium supplementation can be administered using magnesium
gluconate, oxide or hydroxide salts. Potassium chloride may be administered
intravenously or orally.
Digitalis compounds (cardiac glycosides)
atropine (muscarinic receptor antagonist)
Page 6, Classes of Drugs Used to Treat Myocardial Infarction
Anti-arrhythmics by type of arrhythmia…
Condition
Sinus tachycardia
Drug
Comments
Class II, IV
Other underlying causes may need treatment
Class IA, IC, II, III, IV
Ventricular rate control is important goal;
Atrial fibrillation/flutter
digitalis
anticoagulation required
adenosine
Paroxysmal supraventricular
Class IA, IC, II, III, IV
tachycardia
adenosine
AV block
atropine
Acute reversal
Ventricular tachycardia
Class I, II, III
Class II, IV
Premature ventricular complexes
PVCs are often benign and not treated
Mg++ salts
Class IB
Digitalis toxicity
Mg++ salts;
KCl

Anti-thrombotics (prevent thrombus formation)
- anticoagulant
o Warfarin
- anti-platelet drugs
o
o

Aspirin
Ticagrelor (trade name Brilinta in the US
Thrombolytics (dissolve clots - i.e., "clot busters") -- Thrombolytic drugs are used to dissolve (lyse) blood
clots (thrombi).
o There are three major classes of fibrinolytic drugs: tissue plasminogen activator (tPA), streptokinase
(SK), and urokinase (UK).
- plasminogen activators
o
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Analgesics (reduce pain)
- morphine
Adapted from: http://www.cvpharmacology.com/clinical%20topics/myocardial%20infarction-3 , accessed 10-21-15