DRUG AFFECTING CARDIOVASCULAR FUNCTIONPeter Kabo

Physiology & pathophysiology of the cardiovascular systemDrug Affecting Cardiovascular Function

JantungPembuluh darah

ANATOMI SSO

FAAL SSOTransmisi NeurohormonalAcetyl cholineAdrenaline/nor adrenaline

Respon Efektor terhadap perangsangan SSO

Transmisi Adrenergik

Anti Hypertensive Agents

Diuretics

Pharmacological EffectsAdverse effectTherapeutic usesDiuretic Resistance

-methyldopa (Dopamet 250 mg/tab)-methyl dopamine-methyl Noradrenaline

Sympatholytic agents (Anti Adrenergic)Pharmacological Effects:

Pharmacological EffectsIndicationAdverse Effects

KardioselektifISABio Availibilitas Oral (%)Metabolisme lintas I (Hati)t1/2 (jam)ACEBUTOLOL++30 - 50+3METOPROLOL+-40 - 50+3 - 6ATENOLOL+-40 - 60-6 - 8BISOPROLOL+++-9010%11PROPANOLOL--25 - 35+2 - 6PINDOLOL-++95 - 100-3 - 4OKSPRENOLOL-+25 - 50+2SOTALOL--90 - 100-10 - 15TIMOLOL--50 - 75+4 - 5LABETOLOL (Alfa blocker)-+25+5 - 8CARVEDILOL

FarmakodinamikindikasiEfek sampingSistem kardiovaskular(-) inotropik(-) kronotropik resistensi perifer(non-selektif) sekresi renin cardiak output resistensi perifer(pengguna kronis)

Turunkan TDTakikardiTakiaritmiaHipertensiangina pektorisInfark miokardHOCMFeokromasitomaTirotoksikosisGlaukomaGagal jantungBradikardiSaluran nafasBronkokonstriksiBronkospasmeEfek metabolik Asam lemak Trigliserida HDLglikogenolisisHipertrigliseridHipoglikemi!! Putus obat

Penghambat saraf adrenergikClonidineMethyl DopaNegative Feed back mechanism

Calcium Channel Blockers (CCB)

Relative Cardiovascular EffectsVasodilatasiSupression ofContractilityAutomaticityConductionNifedipinDiltiazemVerapamil534124155045

ANGIOTENSIN CONVERTING ENZYME (ACE) - INHIBITORSAdverse effectAngiotensin receptor antagonistsAT1 - antagonists

PENGHAMBAT ACE & ANGIOTENSIN RECEPTOR ANTAGONISTEfek samping:Mekanisme Kerja ACE-I

PreparatKegunaan: Angiotensin antagonis:

ACE - Inhibitors

First line:1. Diuretics2. blockerPharmacological Treatment of HypertensionCompelling indication & drug of choice (except contraindication)

VASODILATORS

ANGINA PECTORIS

Mekanisme kerja

Rebound fenomenaKontraindikasi: Syok &HipersensitifFarmakokinetik :Farmakodinamik :Indikasi

William Withering (1789)Digitalis lanata (foxglove putih)Digitalis purpura (foxglove ungu)Cardiac Glicoside

Farmakokinetik

Sign & Symptoms of Cardiac Glycoside ToxicityDrug interaction with Digoxin

PharmacodynamicManagement of Digoxin toxicity

Efek pada organ lainEfek pada Jantung

Anti Arrhytmic drugs

Mechanism of anti arrhythmias drug actionAnt arrhythmic drugs can cause arrhythmiasSome arrhythmias should not be treated

Classification of anti arrhythmia drugs

Farmakokinetik

OPDosisKadar puncakMetabEksIndikasiEfek sampingKINIDIN++3 X 200 mg60 90HG/HAF, SVTPROKAINAMID++3X (250000 500) mg45 70HGVES, SVTLupus like syndrome, leukopeniDIISOPIRAMID+-3X 100 mg60 120HGVES, SVTMulut kering, konstipasi, penglihatan kaburLIDOKAIN-+1 MG/ KG bb =1mg/ jamHVT (pasca miokard infark)hipotensiPROPAFENON++3 x(150 -300) mg60 180VES

AmiodaronSotalol

FarmakokinetikindikasiEfek sampingOPT1/2DosisVT, AFPro aritmik,Hipotensi, gangguan fungsi: hati, tiroid, paru & mata++25 60 jamLoading 600 s/d 800 mg/ hariMaintenance 300mg/ hari

FarmakokinetikindikasiEfek sampingOPT1/2DosisSVT, VTGagal jantung+-11 jam800 s/d 320 mg/hari

BradicardyHeart BlockAtropine (I.V.)Temporary PacemakerPermanent Pacemaker

Sinus BradicardyEphedrineAminophylineAtropine (I.V.)

Permanent Pacemaker

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