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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