interaksi hipertensi

8/13/2019 interaksi hipertensi

1/17


2/17

$nteracting Drug %echanism

Calcium antagonists" especially ni&edipine Added hypotension

#erapamil' diltiaem

Amiodarone Added nodal inhibition

$nhibitorso&hepaticC*+D,'

cimetidine"ritonavir"-uinidine

Betablockers

Digitalispoisoning

Digoin(D)

#erapamil or diltiaem' ecainide' mostanesthetics

Added negativeinotropic negative

added inhibition o&0A"A# nodes'added

negative inotropic e&&ect


3/17


4/17

Table . 2i&estyle %odi&ications to %anage 3ypertension

2i&estyle %odi&ications to %anage 3ypertension4

%odi&ication 5ecommendation Approimate 0ystolic B* 5edu

6eight reduction %aintain normal body 7eight (B%$" 18.9+:.

Adopt DA03 eating plan Consume a diet rich in &ruits" vegeta

7ith a reduced content o& saturated and total &at

891: mm 3g (1,"1=)

Dietary sodium reduction 5educe dietary sodium intake to no

(+.: g sodium or , g sodium chloride

+98 mm 3g (1,


5/17

ction" 5ange

; kg/m+) 9+< mm 3g/1


6/17


7/17

Drug Interactions

Drug Class/Drug Interacting Drug

Beta blockers

All beta blockers

most anesthetics

Verapamil; diltiazem

Amiodarone

Inhibitors of hepatic CYPD!;

"hepatic interactions#$

car%edilol& labetalol&

Calcium antagonists

Verapamil "V# Beta blockers

Digitalis poisoning

Digo'in "D#

Disop(ramide

)lecainide ")#

*uinidine "*#

Beta blockers

Digo'in "D#

Diltiazem )lecainide ")#

Calcium antagonists&especiall( nifedipine

"hemod(namic

interactions#

Verapamil or diltiazem;flecainide;

"electroph(siologicinteractions#

All lipid+soluble betablockers

cimetidine& ritona%ir&,uinidine

metoprolol&propranolol& probabl(timolol

Prazosin and other alpha

blockers


8/17

Digo'in "D#

Beta blockers; propranolol "P#

Digo'in "D#

-ifedipine "-# *uinidine "*#

Diuretics

.oop and thiazide -AIDs

Probenecid

AC0I& A1Bs

Captopril

.oop Aspirin

Potassium sparing AC0I& A1Bs

0plerenone AC0I

Direct renin inhibitors

-icardipine "see alsonifedipine#

Prazosin "P2#& other alphablockers

Aldosterone receptorantagonist


9/17

Aliskiren

AC0I class effect 0'cess diuretics; rare in

h(pertension

-AIDs

Aspirin

.oop diuretics

Captopril "C#

Probenecid "P#

A1B class effect 0'cess diuretics; rare in

h(pertension

Vasodilators Beta blockers "hepaticall(

metabolized#

3(dralizine -itrates "-#

Verapamil

AC0I& A1B& potassium+sparing diuretics

Angiotensin+

con%erting enz(meinhibitor

Potassium+sparingdiuretics; spironolactone

Immunosuppressi%e drugs&procain amid e4h(dralazin e

Angiotensin receptorblockers


10/17

Cilostazol "C#

Inhibition of P567 8A5;diltiazem& %erapamil&er(throm(cin& ketoconazole&c(closporine


11/17

9echanism Conse,uence Proph(la'is

Added h(potension 1isk of m(ocardial

ischemia

Added negati%e inotropic effect 1isk of m(ocardial Check for C3); ad:ust

failure; h(potension

0'clude sick+sinusn of the lipid?

negati%e inotropic

effectsAdded A and AV nodalinhibition

As(stole; complete3B after IV V

Care duringcotherap(;

Decreased D clearance;inhibition of

check 0C@& BP& heartsize

3(potension&constipation

3al%e D dose; blood Dle%el

3(potension;increased * le%els


12/17

ome fall in D clearance Blood D doubles Check 0C@ and

0'cess h(potension - .V function

Decreased D clearance decreased P le%els; P Check D le%els

Added negati%e inotropism increases - le%els Check .V; ) le%els

- and P ha%e opposite Increased D le%els

effects on blood li%er flo> Postural h(potension

9inor/modest changes in D Decreased * effect dose; read:ust P and

P2 blocks alpha+refle' to - - doses if needed

- impro%es poor .V Check D le%els

function; * clearance faster

Check * le%els

Pharmacod(namic

0'cess diuretics& high renins

A1B

Inhibition of acute

%asodilator response in 3) Dela( aspirin >hen

Both retain potassium 3(perkalemia

1etains potassium 3(perkalemia

Added negati%e inotropiceffects

Decrease; check D

le%els

Check BP& use lo>initial

.o> initial dose of -or P2 or other alphablockers

Decreased anti+h(pertensi%eeffect

Ad:ust diuretic dose oradd another agent

Decreased intratubularsecretion of diuretic

Decreased diureticeffect

0'cessh(potension;prerenal uremia

Increased diureticdose

.o>er diureticdose; initial lo>+dose AC0I or

Possible interference >ithtubular secretion

.oss of diureticefficac( offurosemide

Presumed lessefficac(

Change to anotherAC0I

initiating acute

therap( for 3)

9onitor potassium&reduce AC0I dose

9onitor potassium&reduce AC0I dose


13/17

1etain potassium 3(perkalemia

3igh renin le%els in

risk of renal failure

Added potassium retention 3(perkalemia

.ess %asodilation

.ess %asodilation .ess 3) effects A%oid if possible

.o>+dose aspirin

Added immune effects Increased risk of

neutropenia A%oid combination;

check neutrophils

3igh renin le%els in Decrease C dose

3epatic shunting risk of renal failure

1enal blood flo> ; added ; blood le%els

%asodilation; free radicals .ess - tolerance dose

sca%enged

3epatic metabolism h(potension alpha blocker or

9onitor potassium&reduce or eliminate

AC0I& A1B& or

potassium+sparingdiuretic

)irst+doseh(potension;

o%erdiuresed patients;%olume depletion

1educe diureticdose;

correct %olumedepletion

.ess BP and less antifailureeffect

A%oid combination

or use >ith care

Possible interference >ithtubular secretion

.essened diureticeffect offurosemide

Consider alternateAC0I

P inhibits tubular secretion

of Cmall rise in Cle%els

o%erdiuresed patients;%olume depletion

)irst+doseh(potension;

1educe diureticdose;

Beta+blockermetabolism

correct %olumedepletion

Propranolol;metoprolol

"benefit#; risk ofe'cess

tart >ith lo> doseof an


14/17

hepatic interaction dih(drop(ridine;

calcium blocker

Ad:ust doses

(nergisticantih(pertensi%eeffect

C le%els& risk ofincreased

mortalit( in 3)

.essen C dose ora%oid


15/17

rangkuman

1. &isiologi penyakit

+. tata laksana penyakit penyerta

struktur

1. monograph

clinical evidence

mekanisme keramanaemen interkasi obat

re&erensi


16/17

pertanyaan pada presentasi

no penanya tipe pertanyaan soal

1 sdr vicky masukan terapi diabetes tipe + dimulai dgn insulin menurut 7ho

+ sdri vonny masukan interaksi diabetes pada geriatri

? sdri 7ulan sharing glibenklamid met&ormin

: sdri susan sharing hipertensi sdr vicky hati dan ginal

, sdr ari&in &aktor abnormal glukosa menadi hipertensi

= sdr sophan sharing akarbose untuk diabetes

8 sdr. ul pertanyaan gestional diabetes


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