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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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