chbare Posted October 8, 2008 Share Posted October 8, 2008 Possibly; however, one of the concerns with beta blockade and Cocaine MI is the fact that we could precipitate unopposed alpha stimulation. As we know many vessels are stimulated via alpha receptors. Hence, the alpha effects and increased PVR when we talk about the alpha effects of medications such as norepinephrine. Remember, people with cocaine related MI can have "normal" coronary arteries without the typical evidence of CAD. The cause of the MI differs from say a plaque that ruptures triggering the clotting cascade and occlusion. If we have unopposed alpha stimulation, we can actually cause coronary vasospasm or worsen existing spasm. With that in mind, is there a beta blocker that may have more desirable effects? Obviously, this is more theoretical as people generally caution against using any kind of beta blockade. Take care, chbare. Link to comment Share on other sites More sharing options...
ERDoc Posted October 8, 2008 Author Share Posted October 8, 2008 There was also a study in Annals within the last few months that showed that the concern about the unopposed alpha from cocaine is theoretic and does not seem practical. Link to comment Share on other sites More sharing options...
chbare Posted October 9, 2008 Share Posted October 9, 2008 Yeah, people still caution against beta blockers; however, there is not a large evidence base that supports this idea. With that, nitrates and benzos are still considered front line treatment for cocaine associated MI. Take care, chbare. Link to comment Share on other sites More sharing options...
Arizonaffcep Posted October 9, 2008 Share Posted October 9, 2008 What about your calcium channel blockers, such as dilt? Link to comment Share on other sites More sharing options...
chbare Posted October 9, 2008 Share Posted October 9, 2008 Generally not indicated, especially as front line agents. A few large studies indicate that CCB's do not help and a few sub groups of patients actually developed additional complications. Phentolamine is an alpha blocking agent that can be considered if nitrates and benzo's are not helping. Pushing this a bit further, what does everybody think about fibrinolytic for cocaine induced MI? Take care, chbare. Link to comment Share on other sites More sharing options...
p3medic Posted October 9, 2008 Share Posted October 9, 2008 Negative ghostrider.....The same reason they won't lyse cva w/cocaine use in last 48hrs...vasospasm. Link to comment Share on other sites More sharing options...
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