farmakologi ANTIANGINA

8/17/2019 farmakologi ANTIANGINA

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Bagian FarmakologiFakultas Kedokteran

Universitas Swadaya Gunung Jati

OBAT ANTANGNA

!ama S" Bra#awikal$a%&"%S'"% A$t


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ANGINA

• Angina pectoris is the principle symptom ofischemic heart disease

• The condition is characterized by sudden, severesubsternal pain or pressure

• The primary cause of angina is an imbalance between myocardial oxygen demand and oxygensupplied by coronary vessels

• This imbalance may be due to:

• a decrease in myocardial oxygen delivery

• an increase in myocardial oxygen demand

• or both

! "TA#$% ANGINA&! 'N"TA#$%

ANGINA


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ANGINA "TA#$%

• "table angina is also (nown as:• Typical or classic angina• Angina of e)ort *physical activity+• Atherosclerotic angina

• The underlying pathology is usually

atherosclerosis *reduced oxygen delivery + givingrise to ischemia under conditions where the wor(load on the heart increases *increased oxygendemand+

• Anginal episodes can be precipitated by exercise,cold, stress, emotion, or eating

• Therapeutic goals: Increase myocardial bloodow by dilating coronary arteries and arterioles*increase oxygen delivery +, decrease cardiac load*preload and afterload- decrease oxygendemand+, decrease heart rate *decrease oxygendemand+, .alter myocardial metabolism/0


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ANGINA 'N"TA#$%

• 'nstable angina is also (nown as:• 1reinfarction angina• 2rescendo angina *occurs suddenly+• Angina at rest

• Associated with a change in the character, fre3uency,

and duration of angina in patients with stable angina,and episodes of angina at rest

• 2aused by recurrent episodes of small platelet clots atthe site of a ruptured atherosclerotic pla3ue which canalso precipitate local vasospasm

• 4ay be associated with myocardial infarction• Therapeutic rationale: Inhibit platelet aggregation and

thrombus formation *increase oxygen delivery +,decrease cardiac load *decrease oxygen demand+, andvasodilate coronary arteries *increase oxygen delivery


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Arteri (oronaria


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1roses 1embentu(an1la3ue


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5bat ANTIANGINA

ut( mengobati angina pectoris *nyeri 6antungmendada( a(ibat tida( cu(upnya aliran darah (rnadanya sumbatan pd arteri (oroner yg menu6u

6antung+

4acam& Angina:

! "table Angina7(lasi(

&! 'nstable Angina7pra infar(

8! 1rinz 4etal7 varian

1enyempitan7sumbatan a! (oroner

vasospasme


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Isosorbid4ononitrat

$ong acting interval 9;

hours


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Nitrogliserin mengalami frst past eek diberi(an

scr sublingualmg atau 7?= grain stlh mengalami

nyeri 6antung, diulang setiap ? mnt sampai 8 dosis

#entu( lain: ointment, patch transdermal dan I@


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arma(o(ineti( Bfarma(odinami(

%%C T%DA1%'TIC 4e (ebut! 5(sigen

mio(ard4e preload dg dilatasi

vena

lbh sd(t darahyg (embali4e afterload dg dilatasiarteri,shg te(!tahanan

ber

NTG:"$: 4ula: 8 mnt1: > mnt -$: &=8= mnt

15: 4ula:&=9= mnt1: & 6am - $: ;& 6am

"alep: 4ula: &=9= mnt$: 8; 6am1acth: 4ula: 8=9= mnt1: & 6am- $: &=>= 6amI@ : 4ula: 8 mnt - $:

mntIsosorbid:"$: 4ula: ? mnt - $: =,? E &

6am15: 4ula: &=>= mnt1: 8=>? mnt -$: >9 6am

Nitrogliserin, isosorbid:Absorbsi "$: F?H"aluran GI: ?=9=H"alep B pacth:transdermal NTG:diabsorbsi dg lambatI@ : F=H mnt

%leminasi: hati

Jipotensi ortostati( smphipotensi berat, ta(i(ardia,

bingung, pucat, lemah, ruam

(ulit

"a(it (epala, pusing,ingin pingsan, mual


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Menis 22#• (i)ydro$yridine berasal dari mole(ul

dihydropyridine dan dapat menurun(anresistensi sistemi( vas(uler dan te(ananarteri!


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• Non (i)ydro$yridine"


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4e(anisme Cer6a

•

me

(ontra(tilitas 6antung *efe( inotropi( negatif+ danbeban (er6a 6antung

• 4e (ebut! 5& mio(ard angina (lasi(

• 4erela(sasi(an a! (oroner angina 1rintz metal


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4e(anisme A(si


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%fe( Antagonis Calsium

•

"a(it Cepala• Jipotensi *$bh "ring pd nifedipin dan lbh 6arang pd

diltiazem+

• 1using

• lushing 1ada Culit

• Dee(si ta(i(ardia dpt ter6adi a(ibat hipotensi

• 1erubahan& fungsi hati, gin6al dan enzim hati dlmserum


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%)ects of 2alcium 2hannel

#loc(ers*adapted from Goodman B Gilman, th ed!+

@erapamil


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Tabel 1enghambat rantai (alsium u7 angina

OBAT (OSS *+&AKAAN (AN*+!T&BANGAN

@erapamil *2alan+

=&= mg dlm,t!i!d!I@: ?= mg selama &mnt

'ntu( angina!


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4e(anisme

4nghambat reseptor #eta me denyut 6antung B

(ontra(tilitas mio(ard't( obat antiangina, antidisritmia, antihipertensi

4acam&nya:

1enghamat beta tida( sele(tif *mOhmbt beta dan

beta&+

ex: propanolol*Inderal+, nadolol*2ogard+,pindolol*@i(sen+

1Ohmbt beta *6antung+ sele(tif mOhmbt beta ex: atenolol *Tenormin+, metoprolol *$opresor+


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p!o diabsorbsi dg bai(- (apsul sustained"release

lambat%": pe JD dan T


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• T%DI4ACA"IJ

farmakologi ANTIANGINA

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