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THROMBOLITYC
ANTI ARRYTHMIA
PROF MOCH ARIS WIDODO PhD
DEPARTMENT PHARMACOLOGY AND THERAPY
MEDICAL FACULTY BRAWIJAYA UNIVERSITY
RISK FACTORS
SMOKING
OBESITY
HYPERTENSIV
METBOLIC SYNDROME
ACUTE
CORONARY
SYNDROME
ANGINA
MIOCARD INFARCT
ARRYTMIA
ANGINA PECTORIS
NYERI DADA YANG BERASAL DARI JANTUNG DAN
SERING KALI MENJALAR SAMPAI UJUNG JARI DAN
KE BAHU
PENYEBAB :
SUPLAI OKSIGEN DAN BAHAN MAKANAN BERKU
RANG OLEH ARENA PENYEMPITAN PEMBULUH
DARAH KORONER OLEH PENYUMBATAN ATAU
TERJADI VASOKONSTRIKSI KPORONER
DIASTOLE
AORTA
ARTERI KORONARIA
VENTRIKEL KIRI
SISTOLE
TYPE TYPE ANGINA PECTORIS:
PEMASANGAN STENT
VASODILATOR PERIPER
MENGURANGI PRELOAD DAN
AFTER LOAD
OBAT OBAT UNTUK ANGINA
SHORT DURATION
INTERMEDIATE
LONG DURATION
KELOMPOK NITRAT
+
NITRAT MENINGKATKAN SINTESA C GMP
DERIVAT DYHYDROPYRIDINE
NIFEDIPINE
DILTIAZEM
VERAPRAMIL
EFEK SAMPING
BBETA BLOKER JUGA MENCEGAH IKATAN
NEROTRANSMITER DENGAN RESEPTOR BETA 2
DENGAN AKIBAT BRONCHO KONSTRIKSI
BETA BLOKER
EFEK SAMPING
BBETA BLOKER JUGA MENCEGAH IKATAN
NEROTRANSMITER DENGAN RESEPTOR BETA 2
DENGAN AKIBAT BRONCHO KONSTRIKSI
MIOCARD INFARCT
ACUTE CORONARY SYNDROMES
AND THROMBOLITYC
ANGINA UNSTABLE
CRESCENDO ANGINA
MIOCARD INFACRT
Stable plaque
restabilized
rupture
Emboli
troponin
thrombosss
Gp Iib/IIIa
Anti aggregratory
Via prostacyclin
Vasodilatory
Via nitric oxide
Anti thrombotic
Via thrombomedulin
Platelet inhibitor
Prevent AMI
TIA (aspirin)
Damaged vascular endothelium
Platelet adhesion
Anticoagulant given
Platelet activation
Acutely to prevent
Platelet aggregration
Further formation of
Fibrin (heparin)
Clotting mechanism
To prevent thrmbo
Formation of fibrin
Embolism (warfarin)
Back bone of thrombus
Clinical sydrome of
Acute myocard infarct
Fibrinolytic agents
Peripheral arterial thrmbosis
For clinical syndromes
AMI and phripheral
Arterial thrombosis
EARLY PHASE AMI
RUSH TO ICU
RAPID LYSIS PCI
PAIN RELEIF
ASPRIN
BETA BLOCKER
ACE INHIBITOR
FUTUE STEM CELL
REPERFUSION
CHRONIC PHASE
STATIN REMODELLING
ASPIRIN /CLOPIDOGREL PREVENT CHV
ACE INHIBITOR ACE INHIITOR
PCI / BYPASS BETA BLOKER
HYPERTENSI
PREVENT SUDDED
DEATH
BETA LOCKER
ANTI PLATELET AGENTS
TICLOPIDINE : thienoyridine derivat irreversibly inhibit the
binding of ADP to is receptor on the platelets
side effects : neutropenia, thrombocytopenia
CLOPIDOGREL: same as above, lower myelotoxiciy, GI effects
same as aspirin
ASPIRIN
ASPIRIN RESISTANCE
+30 KONDUKSI
ADANYA BLOK
0 AUTOMATISITY
FREKUENSI
- 90
Two major forms of triggered rhythms are recognized. In the first case, under
conditions of intracellular Ca2+ overload (e.g., myocardial ischemia,
adrenergic stress, digitalis intoxication, or heart failure), a normal action
potential may be followed by a delayed afterdepolarization (DAD). If this
afterdepolarization reaches threshold, a secondary triggered beat or beats
may occur.
In the second type of triggered activity, the key abnormality is marked
prolongation of the cardiac action potential. When this occurs, phase 3
repolarization may be interrupted by an early afterdepolarization (EAD).
When cardiac repolarization is markedly prolonged, polymorphic
ventricular tachycardia with a long QT interval, known as the torsades de
pointes syndrome, may occur. Congenital long QT syndrome, a disease in
which torsades de pointes is common, can be caused by mutations in the
genes encoding the Na+ channels or the channels underlying the
repolarizing currents
Re-entry
SUPRAVENTRIKULER VENTRIKULER
OBAT OBATAN
DIGITALIS ANTI ARRITMIA
THEOPHILIN CATHECOLAMINE
TRISIKLIK ANTI DEPRESAN PHENOTHIAZINE
ANOREKSIAN OBAT ANAESTHESI
FAKTOR JANTUNG
ISKEMIA JANTUNG CHF
PENYAKIT LAIN
THYROTOKSIKOSIS LUNG DISEASE
GANGGUAN METABOLIK
ASIDOSIS ALKALOSIS
HYPOKSIA HYPERKALEMIA
HYPOMAGNESEMIA HYPOKALEMIA
DIHILANGKAN PENYEBAB
LAIN –LAIN
DATA FARMAKOKINETIK OBAT ARITMIA YANG DIBERIKAN
SECARA INTRA VENA
PROPANOLOL 1-5 MG
PENYAKIT DAN OAT OBAT
YANG MENYEBABKAN PERUBAHAN FARMAKOKINETIK
NON CARDIAC
PENYAKIT GI QUINIDINE
PROSTATISM, RETENSI URINE
GLAUCOMA DYSOPYRAMIDE
ARTRITIS INFLAMASI MEXILETIN , TOCAINIDE
TREMOR LIDOCAIN
BRONCHO SPASM BETA BLOKER, PROPAFENONE
PENY. PARU AMIODARONE
PSIEN MUDA AMIODARONE, PRODCAINAMIDE
CARDIAC
CHF DYSOPYRAMIDE, FLECAINIDE,
STENOSIS AORTA BETA ANTAGONIS, VERAPRAMIL,
CARDIOMYOPATHI BRETYLIUM, KELAS 1 a dan III
HYPERTENSI PU;LMONAL