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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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