ANTIANGINA
ANTIARITMIA
Penyebab
Menghindari
beban berat
KLASIFIKASI OBAT ANTIANGINA
NITROGLISERIN
NITRAT
ISDN/ ISMN
(VASODILATOR KORONER)
ANTIANGINA
DIPIRIDAMOL
BETA-BLOCKERS
VERAPAMIL
DIHIDROPIRIDIN:
NIFEDIPIN
MEKANISME
KERJA
MEKANISME KERJA NITRAT
(VASODILATOR KORONER)
MEMPERLEBAR ARTERI
JANTUNG,
MEMPERLANCAR
PEMASUKAN DARAH SERTA
OKSIGEN,
SEHINGGA MERINGANKAN
BEBAN KERJA JANTUNG
NITRAT (VASODILATOR KORONER)
Nitrogliserin Membentuk nitrogenoksida (NO) dari nitrat di sel-sel dinding
pembuluh. NO bekerja mengendurkan sel-sel ototnya, sehingga
pembuluh terutama vena mendilatasi dengan langsung.
Akibatnya, TD turun dengan pesan dan aliran darah vena yang
kembali ke jantung berkurang. Penggunaan oksigen jantung
menurun dan bebannya dikurangi. Arteri koroner juga diperlebar,
tetapi tanpa efek langsung terhadap miocard.
Isosorbida- Derivat nitrat siklis ini sama kerjanya dengan nitrogliserin, tetapi
5- bersifat long-acting. Di dinding pembuluh zat ini diubah menjadi
mononitrate nitrogenoksida (NO), yang mengaktivasi enzim tertentu. Karena
itu, kadar cGMP (cyclo Guanyl-Mono-Phosphate) di sel otot polos
dan naik dengan akibat vasodilatasi.
Isosorbida-
dinitrat
ISOSORBID DINITRAT
ISOSORBID MONONITRAT
• angina stabil kronis, pada angina variant kadang positif kadang negatif
VERAPAMIL
DILTIAZEM
NIFEDIPIN
Tablet: 2,5
Oral profilaksis angina, 2,6-2,8 mg 3 kali se
hari
S
mg & 5 mg atau 10 mg 2-3 kali sehari. I
2 Isosorbide- Tablet: Awal 3 dd 10 mg, sesudah beberapa hari 2-
5- 20mg 3 dd 20 mg S
mononitrate Tablet retard: 50-120 mg
Retard:
60 mg
DOSIS
No Nama Obat Sediaan Dosis anjuran
3 Isosorbid Tablet: 5mg, 1 Sublingual, 5-10 mg.
dinitrat 0mg, 20mg Oral, sehari dalam dosis terbagi, angina 30-120
Infus: 1mg/ml mg; gagal jantung kiri 40-160 mg, sampai 240
@10ml mg bila diperlukan.
Retard: 20mg Infus intravena, 2-10 mg/jam; dosis lebih tinggi
sampai 20 mg/jam mungkin diperlukan.
• VSS (distribusi volume pada keadaan tetap) ISDN adalah 2-4 L/Kg
BB/menit. Kerja obat per oral adalah moderat hingga long-acting,
sedangkan kerja obat sublingual adalah rapid-acting serta berakhir
dalam jangka waktu pendek.
DISTRIBUSI
ISDN
• Secara ekstensif di hepar, ISDN dirubah menjadi
metabolit yang terkonjugasi. Hasilnya adalah
terdapat dua metabolit aktif secara biologis yaitu 2-
isosorbide mononitrate (2-ISMN) dan 5-isosorbide
METABOLISME
mononitrate (5-ISMN).
• Diserap dengan baik setelah pemberian oral tablet konvensional, tetapi hanya
sekitar 20-35% dari dosis oral mencapai sirkulasi sistemik sebagai obat tidak
berubah karena metabolism lintas pertama.
ABSORPSI
• Kategori: C
• Laktasi: belum diketahui dapat diekskresi melalui
ASI atau tidak.
• Anak: Nitrogliserin tidak disarankan bagi anak-anak
berusia 18 tahun ke bawah
• Kategori: C
• Laktasi: Tidak diketahui apakah isosorbid dinitrat
dan isosorbid mononitrat didistribusikan ke susu
(ASI). Perhatian jika digunakan pada wanita
menyusui
BETA-BLOCKERS
VERAPAMIL
• Kategori: C.
• Laktasi: Didistribusikan ke dalam susu; menghentikan
menyusui atau obat.
• Anak: Mungkin efek samping yang parah kardiovaskular
(misalnya, hipotensi refrakter, serangan jantung) setelah
pemberian IV dari verapamil pada neonatus dan infants. Jika
digunakan pada anak-anak, sarankan hati-hati. Beberapa ahli
menyatakan verapamil yang tidak boleh digunakan pada bayi.
• Keamanan dan kemanjuran verapamil oral tidak pada anak-
anak <18 tahun.
DILTIAZEM
• Kategori: C
• Laktasi: Didistribusikan ke dalam susu (ASI), hentikan
menyusui.
• Anak: Keamanan dan kemanjuran tidak diketahui.
NIFEDIPIN
• Kategori: C
• Laktasi: Didistribusikan ke susu (ASI). Hentikan menyusui
atau hentikan obat.
• Anak: Keamanan (safety) dan kemanjuran (Efikasi) tetap
sepenuhnya diketahui pada penggunaan anak-anak;
Namun, beberapa ahli telah merekomendasikan dosis
untuk hipertensi berdasarkan pengalaman klinis yang saat
ini terbatas
EFEK
SAMPING
NITROGLISERIN, ISDN & ISMN
VERAPAMIL
NIFEDIPIN
NIFEDIPIN
BETA-BLOCKERS
ABSORPSI
DISTRIBUSI
TEXT HERE
METABOLISME
EKSRESI
TEXT HERE
ABSORPSI
DISTRIBUSI
TEXT HERE
METABOLISME
EKSRESI
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