Acute MI (Heart Attack) ka loding dose
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Ab mere paas pura data hai. Comprehensive answer deta hoon:
Acute MI (Heart Attack) - Loading Doses
🔴 ANTIPLATELET DRUGS (Loading Dose)
| Drug | Loading Dose | Maintenance Dose | Notes |
|---|---|---|---|
| Aspirin | 162-325 mg (chewed/crushed) | 81-325 mg/day indefinitely | Sabse pehle dena hai - non-enteric coated |
| Clopidogrel | 300-600 mg PO | 75 mg/day | STEMI PCI mein 600 mg preferred; NSTEMI mein 300 mg |
| Prasugrel | 60 mg PO | 10 mg/day | Clopidogrel se zyada potent; >75 yr, <60 kg, stroke/TIA history mein AVOID |
| Ticagrelor | 180 mg PO | 90 mg BD | Aspirin dose 100 mg se zyada na ho; mortality benefit over clopidogrel |
| Cangrelor | 30 µg/kg IV bolus | 4 µg/kg/min infusion | Sirf PCI ke time use |
Dual antiplatelet therapy (DAPT) = Aspirin + ek P2Y12 inhibitor (clopidogrel/prasugrel/ticagrelor) - standard of care hai.
🔵 ANTICOAGULANT DRUGS (Loading Dose)
| Drug | Loading / Bolus Dose | Maintenance | Notes |
|---|---|---|---|
| UFH (Unfractionated Heparin) | PCI: 70-100 units/kg IV bolus | 12 units/kg/hr; aPTT 50-70 sec | Fibrinolysis ke saath: 60 units/kg (max 4000 units) |
| Enoxaparin (LMWH) | 30 mg IV bolus, phir 15 min baad 1 mg/kg SC | 1 mg/kg SC q12h | >75 yrs mein loading dose NA do; 0.75 mg/kg SC q12h |
| Bivalirudin | 0.75 mg/kg IV bolus | 1.75 mg/kg/hr | PCI mein use; prior heparin bolus lene walon mein stent thrombosis kam |
| Fondaparinux | 2.5 mg IV bolus | 2.5 mg SC daily | Thrombolysis ke saath superior; PCI mein catheter thrombosis risk |
🟢 GLYCOPROTEIN IIb/IIIa INHIBITORS (Loading Dose)
| Drug | Loading Dose | Maintenance |
|---|---|---|
| Abciximab | 0.25 mg/kg IV bolus | 0.125 µg/kg/min (max 10 µg/min) × 12 hr |
| Eptifibatide | 180 µg/kg IV bolus × 2 (10 min apart) | 2.0 µg/kg/min × 18 hr |
| Tirofiban | 25 µg/kg IV bolus | 0.15 µg/kg/min × 12-18 hr |
🟡 THROMBOLYTICS / FIBRINOLYTICS (Jab PCI available na ho)
| Drug | Loading / Regimen |
|---|---|
| Streptokinase | 1.5 million units IV over 60 min |
| Alteplase (tPA) | 15 mg IV bolus → 0.75 mg/kg over 30 min → 0.5 mg/kg over 60 min (max 100 mg) |
| Tenecteplase (TNK) | Single IV bolus - weight-based (30-50 mg) |
| Reteplase | 10 units IV bolus × 2 doses (30 min apart) |
🟠 OTHER IMPORTANT DRUGS (Acute Phase)
| Drug | Loading/Initial Dose | Notes |
|---|---|---|
| Nitroglycerin | 0.4 mg SL q5min × 3 doses, phir 10-200 µg/min IV | Hypotension mein avoid; inferior MI mein caution |
| Morphine | 1-4 mg IV, repeat q5-30 min PRN | Chest pain ke liye |
| Metoprolol (IV) | 5 mg IV q2-5min × 3 doses | Hypertension/tachycardia mein; heart failure/cardiogenic shock mein AVOID |
| Captopril | 6.25 mg q8h (starting dose) | Anterior MI, LV dysfunction mein 24 hr ke andar shuru karo |
| Atorvastatin | 80 mg/day (high-intensity) | Admission se hi start karo |
⚡ QUICK MEMORY - STEMI Management Order
- Aspirin 325 mg (chewed) - turant dena
- P2Y12 inhibitor - Clopidogrel 600 mg / Prasugrel 60 mg / Ticagrelor 180 mg
- Anticoagulation - UFH/Enoxaparin
- Primary PCI (goal: door-to-balloon <90 min) - BEST option
- Agar PCI available nahi → Thrombolysis (30-60 min mein)
- Nitroglycerin, Morphine, O2 (SpO2 <90% ho tab)
- Beta-blocker, ACE inhibitor, Statin
Sources:
- Goldman-Cecil Medicine - Table 58-7, Antiplatelet/Anticoagulation section
- Washington Manual of Medical Therapeutics - Upstream Medical Therapy table
- Katzung's Basic & Clinical Pharmacology, 16th Ed - Thienopyridines section
- Braunwald's Heart Disease - Dosages section
⚠️ Clinical Note: Prasugrel >75 years, <60 kg, ya stroke/TIA history wale mein AVOID karna hai. Ticagrelor ke saath aspirin dose 81-100 mg se zyada nahi dena.
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