The pharmacotherapy for acute myocardial infarction (AMI) involves a combination of established and evolving treatments. Oxygen, nitroglycerin, aspirin, and occasionally morphine form the fundamental therapy, aimed at addressing the primary cause of coronary atherosclerotic thrombus. Early administration of cardioprotective drugs like beta-blockers is crucial due to their proven benefits in reducing myocardial oxygen demand and mortality. While ACE inhibitors have demonstrated benefits in chronic conditions, their routine use in the emergency department for AMI is not always necessary. Heparin, including both unfractionated heparin (UFH) and low molecular weight heparins (LMWHs), plays a well-defined role in preventing further thrombus formation. Additionally, glycoprotein IIb/IIIa inhibitors are emerging as valuable additions to the pharmacological toolkit, particularly in high-risk patients or those undergoing percutaneous coronary intervention (PCI).