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FARMAKOTERAPI KARDIOVASKULAR By: Rara Merinda Puspitasari, M. Farm., Apt INSTITUT SAINS DAN TEKNOO!I NASIONA

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7/21/2019 FARMAKOTERAPI KARDIOVASKULAR

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FARMAKOTERAPI

KARDIOVASKULAR

By:

Rara Merinda Puspitasari, M. Farm., AptINSTITUT SAINS DAN TEKNOO!I NASIONA

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PENYAKITKARDIOVASKULAR BERHUBUNGANDENGAN JANTUNGDAN PEMBULUHDARAH

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HIPERTENSI

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HIPERTENSI

% $ipertensi dide&inisi'an se(a)ai suatupenin)'atan te'anan dara* sist+i' dan ataudiast+i' dari niai n+rma

% Saa* satu &a't+r resi'+ m+r(iditas danm+rtaitas a'i(at penya'it 'ardi+-as'uar dari'erusa'an +r)an pada antun), +ta', 'idney, andeyes.

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PENYEBAB

HIPERTENSI

% $IPERTENSI

PRIMER /01/2 3'asus4 Penye(a( Tida'

di'eta*ui

% $IPERTENSISEKUNDER 21503'asus

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PATOFISIOLOGI

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FARMAKOTERAPI $IPERTENSI

TERAPI FARMAKOO!I

TERAPI NONFARMAKOO!I

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TERAPI NONFARMAKOO!I

 2160 mm$)750 ')

 8159 mm$)

 618 mm$)

619 mm$)

 

91/ mm$)

STOP SMOKING!!!!

Approximate Syto!i" BPre#$"tio%& Ra%'e

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KOMPLIKASIDAN FAKTOR

RESIKO

PENYAKITKARDIO

VASKULARAKIBAT

HIPERTENSI

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TARGET PENURUNAN TEKANAN DARAH

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TERAPI FARMAKOLOGI

  ( I   R  S  T  L I   N  E

    •   A  )  E I   N   H I  B I  T   O   R

    •   A   N   G I   O  T  E   N  S I   N I I   R  E  )  E  P  T   O   R  B  L   O   K  E   R  *   A   R  B  +

    •   D I   U   R  E  T I   K

    •  )   A  L  ) I   U   M  )   H   A   N  E  L  B  L   O  )   K  E   R

  S  E  )   O   N   D  L I   N  E

    •  B  E  T   A  B  L   O  )   K  E   R

    •   A   N  T   A   G   O   N I  S   A  L   D   O  S  T  E   R   O   N

    •   A  L  (   A  B  L   O  )   K  E   R

    •  )  E   N  T   R   A  L   A  L  P   H   A  ,  -

   A   G   O   N I  S  T

    •   V   A  S   O   D I  L   A  T   O   R  L   A   N   G  S   U   N   G

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ACE INHIBITOR (Angiotensin Conveting

En!"#e In$i%ito&

4 Mekanisme: Seaa "an#s$n# men#%am&a'en(im )an# men#$&a% an#i*'ensin I men+a,i

 &en'$k ak'i- an#i*'ensin II .men)e&a&kane"aksasi /em&$"$% ,aa%0 1as*,i"a'asii ,an

 &ek$an#n)a kek$a'an k*n'aksi +an'$n#2 ,anseaa 'i,ak "an#s$n# men#$an#i /*,$ksi

a",*s'e*n .men)e&a&kan e'ensi ka"i$m ,an%i"an#n)a na'i$m2 334 TD men$$n

4  ACE in%i&i'* ,a/a' men)e&a&kan%i/eka"emia ka,a ka"i$m se&aikn)a,im*ni'*

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ACE INHIBITOR (Angiotensin Conveting

En!"#e In$i%ito&

4  ACE in%i&i'* +$#a mene#a% inak'i1asi &a,)kinin menam&a% 1as*,i"a'asi ,#n /enin#ka'an ka,a Ni'i'Oksi,a .NO2

4 Ka,a &a,ikinin 44 men)e&a&kan ES Ba'$k n*n/*,$k'i- 

4 ES "ain : An#i*e,ema ./em&en#kakan /, &i&i0 "i,a%0,an m$"$'0 'eka,an# me"in#k$/i ma'a ,an sa"5 Na-asa'as

4 C*n'*% *&a': Ca/'*/i"0 Lisin*/i"0 ena"a/i"0

ami/i"0 ,""

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ANGIOTENSIN RECEPTOR BLOCKER

4 Me'anisme: seara '+mpetiti& dan an)sun)mene)a* an)i+tensin I menempati resept+ran)i+tensi II se*in))a men)uran)i -as+'+ntri'si

 y) diindu'si +e* an)i+tensin, rea(s+r(si natriumdan pen)euaran ad+ster+n.

4 Farma'+dinami' mirip d)n A;E in*i(it+r, ES (atu' n+n pr+du'ti& e(i* aran)

4 ;+nt+*: -asartan, andesartan, ir(esartan,temisartan

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DIURETIKA

% Me'anisme: men)*am(at reas+r(si natriumpada tu(uus )ina (ai' seara an)sun)

maupun tida' an)sun)

% ;+nt+* : ++p diureti' <&ur+semid, (umetanide=,Diureti' Tia>ide <$idr+*+rt*ia>ide,

indapamide=, P+tassium sparin) diureti<spir+n+a't+n, ami+ride, triamterene=

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CALCIUM CHANEL BLOCKER% Me'anisme: men)*am(at masu'nya i+n 'asium meaui

saurannya pada +t+t p++s se*in))a menye(a('an rea'sasi+t+t antun) dan +t+t *aus men)uran)i te)an)an peri&er.

% ES ter)antun) tipe ;;B : &us*in), edema peri&er,ta'i'ardia, (radi'ardia, heart block, '+nstipasi

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% BETA BO;KER 4 Seara '+mpetiti& men)anta)+nis adren+sept+r

 (eta menurun'an ura* antun)

4 ;+nt+*: aten++, (is+pr++, pr+pan++

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K'si)i*si %et+%'o,*e

% !enerasi pertama<Pr+pran++, S+ta+, Tim++,and Nad++=, n+nsee'ti& (e'era pada resept+r

?5 dan ?6.

% B+'in) ?51reept+rs mempen)aru*i au ntun), '+ndu'si antun) dan '+ntra's antun).

%  B+'in) ?61reept+rs, enderun) menye(a('an'+ntra's +t+t p++s seperti (r+n'+spasma

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% !enerasi 'e6 merupa'an ardi+seeti-e a)ents<Aten++, Bis+pr++, ;eipr++, and Met+pr++=

% Mem(+' ?51reept+rs pada d+sis renda* atauterapi, tetapi dapat mm(+'in) ?61reept+rs padad+sis tin))u

%  me'anisme y) e(i* see'ti& e(i* ++' untu'pasien d)n penya'it paru 'r+ni' dan dia(etesmeitus.

% Kardi+see'ti&itas (er-ariasi dan yan) pain)

see'ti& adaa* (is+pr++.

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% T*e t*ird )enerati+n a)ents *a-e -as+diat+ry pr+perties

%  T*ere ati+n is eit*er seeti-e <Ne(i-++= +r n+nseeti-e

<;ar-id++ and a(et++=.%  T*e -as+diat+ry pr+perties are mediated eit*er (y nitri +@idereease as &+r Ne(i-++ +r ;ar-id++ +r (y added ap*aadrener)i (+'ade as in a(et++ and ;ar-id++.

%  me'anisme -as+diatasi )en 'e meaui ?61intrinsi

sympat*+mimeti ati-ity <ISA= seperti pd Pind++ and Ae(ut++

% Beta (+'er terse(ut +e* 'arena itu mmpnyai 'emamuanmenstimuasi dan u)a d)n (ersamaan mem(+'in) resept+radrener)i' se*in))a enderun) dapat menye(a('an (radi'ardia

dan rasa din)in pd e'strimitas

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ALFA BLOCKER4 Me'anisme: mendudu'i a&a5 adren+sept+r

se*in))a men)*am(at e&e' n+radrenain 11

diatasi pem(uu* arteri dan -ena, men)uran)idenyut antun)

4 ;+nt+*: Pra>+sin, d+@a>+sin dan tera>+sin

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% ;ENTRA AP$A61A!ONIST4 Me'anisme: (e'era sentra se(a)ai antiadrener)i' y)

mnye(a('an stimuasi a&a6 adren+sept+r pada +ta'men)*asi'an diatasi arteri dan -ena tanpa men)u(a*ardia +utput dan au antun).

4 ;+nt+*: metid+pa, '+nidin

;+nidin Biasanya di)una'an untu' *ipertensi resisten Metid+pa merupa'an pii*an utama untu' *ipertensi pd

'e*amian

%  "as+diat+r an)sun) arteri

4 Me'anisme: (e'era mem(eri'an e&e' -as+diat+ran)sun) pada +t+t p++s pem(uu* dara* yan)d+minan pada arteri den)an sedi'it e&e' pada -ena.

4 ;+nt+*: *idraa>ine dan min+@idi

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OBAT ANTIHIPERTENSI GOLONGAN BARU

% AISKIREN4 Me'anisme: men)*am(at en>im renin seara

an)sun) renin pasma menurun TD mnurun4  Ca'tu paru* 69 am d+sis se*ari se'ai

4 Dapat di)una'an untu' m+n+terapi maupun'+m(inasi ,

4 Peneitian (m (ny' s*) (m mnadi +(at pii*anutama

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ALOGARITMA PENGOBATAN HIPERTENSI

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-NC . TAHUN /012

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Hypertensive Urgency and Emergency

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RESISTANT HYPERTENSION% Merupa'an 'e)a)aan daam menapai TD aaupun sd* mn))una'an )+ +(at termasu'

diureti' 

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KOMBINASI TETAP ANTIHIPERTENSI

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MONITORING KLINIK% PRO!RESIFITAS

PEN#AKIT

% EFIKASI% TOKSISITAS

% KEPATU$AN

% ABOATORIUM

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GAGAL JANTUNG

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GAGAL -ANTUNG% $eart &aiure <$F= is de&ined as t*e inadeuate a(iity +& t*e *eart t+ pump en+u)* (++d t+

meet t*e (++d &+ and meta(+i demands +& t*e (+dy 

% $i)*1+utput $F is *arateri>ed (y an in+rdinate inrease in t*e (+dys meta(+i demands, *i* +utpaes an inrease in a,ia *$'/$' .CO2 +& a )eneray n+rmay &unti+nin)*eart. M+re +mm+ny, $F is a resut +& + ;O se+ndary t+ impaired ardia &unti+n.

% $eart &aiure is a inia syndr+me *arateri>ed (y a *ist+ry +& spei&i si)ns and sympt+msreated t+ +n)esti+n and *yp+per&usi+n.

% As $F an +ur in t*e presene +r a(sene +& &uid +-er+ad, t*e term G*eart &aiureH ispre&erred +-er t*e &+rmer term G+n)esti-e *eart &aiure.H

% $eart &aiure resuts &r+m any strutura +r &unti+na ardia dis+rder t*at impairs t*e

a(iity +& t*e -entrie t+ &i it* +r eet (++d.% Many dis+rders su* as t*+se +& t*e periardium, epiardium, end+ardium, +r )reat -essesmay ead t+ $F, (ut m+st patients de-e+p sympt+ms due t+ impairment in e&t -entriuar<"= my+ardia &unti+n.

% T*e p*rase Gaute *eart &aiureH <A$F= is used t+ si)ni&y eit*er an aute de+mpensati+n +& apatient it* a *ist+ry +& *r+ni *eart &aiure +r t+ re&er t+ a patient presentin) it* ne1+nset $F sympt+ms.

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-NC . TAHUN /012

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KLASIFIKASI GAGAL -ANTUNG