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21042012Pleno pakar Pc Blok CVS
Dr.Datten Bangun MSc,SpFK
Dep.Farmakologi & TherapeutikFak.Kedokteran USU ,MEDAN
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I started a joke,
which started the whole world crying,
but I didn't see that the joke was on me, oh no.
Alfred Nobel
Bee Gees
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Treatments for a heart attack
Cardiovascular medications
Angioplasty
Coronary artery bypass surgery Lifestyle changes to reduce the risk of a
repeat heart attack or other heart problems,
called secondary prevention
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Cardiovascular medications
used in the hospital as well as after hospital
discharge.
Medications in the hospital setting are used
to:
Relieve chest pain and anxiety
Limit the size of the heart attack Reduce the work of the heart
Prevent and treat complications
http://www.ehealthmd.com/library/heartattack/HA_meds.htmlhttp://www.ehealthmd.com/library/heartattack/HA_meds.htmlhttp://www.ehealthmd.com/library/heartattack/HA_meds.htmlhttp://www.ehealthmd.com/library/heartattack/HA_meds.htmlhttp://www.ehealthmd.com/library/heartattack/HA_meds.htmlhttp://www.ehealthmd.com/library/heartattack/HA_meds.htmlhttp://www.ehealthmd.com/library/heartattack/HA_meds.htmlhttp://www.ehealthmd.com/library/heartattack/HA_meds.html7/29/2019 21042012Pleno Pakar Pc Blok CVS
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Medications To Relieve Chest Pain
And Anxiety:
include :
= nitrates such as nitroglycerin and
= narcotic pain relievers such as morphine.=Benzodiazepines, which are minor
tranquilizers or antianxiety agents can help
relieve anxiety.
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Coagulation Modifier Drugs
Anticoagulants Inhibit the action or formation of clotting factors Prevent clot formation
Antiplatelet drugs Inhibit platelet aggregation Prevent platelet plugs
Thrombolytic drugs Lyse (break down) existing clots
Hemostatic or Antifibrinolytic drugs Promote blood coagulation
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Nitrates:
Dilates both the artery and vein which is not
sclerotic yet
Reduce heart work thru decreasing total
peripheral resistance ==== hati-hati padalow BP=== semaput or reflex tachycardiaheart work increase
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ORGANIC
NITRATES
Organic nitrates & nitrites aresimple nitric & nitrous esters ofglycerol.
cause a rapid decrease in
myocardial oxygen demandleading to rapid resolution ofsymptoms.
Nitrates are effective for all typesof angina.
Activation of guanylate cyclaseincreases cGMP activating acGMP kinase leading todephosphorylation of myosin
light chains decreasing contractileforce.
Requires
normal
vascular
endotheliumDiffuses tolocal vascularsmooth muscle
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Nitrates:
Intravenous nitroglycerin is recommended forthe first 24 to 48 hours after a heart attack inpatients with :
An acute heart attack complicated by congestiveheart failure
A large heart attack affecting the front wall of theheart, called an anterior-wall myocardialinfarction
Persisting insufficient blood flow to heart muscle,as detected by pain and ECG
Hypertension or high blood pressure
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to relieve chest discomfort
Morphine and other narcotic pain relievers
are used to relieve chest discomfort
associated with a heart attack.
Repeat dosages of morphine can be given
intravenously frequently if breathing remains
normal and no signs of toxicity occur.
Side effects of narcotic pain relievers include
nausea and pruritus (itching).
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Medications To Limit The Size Of The Heart
Attack:
Most heart attacks are caused by a blood clot
blocking a coronary artery===useThrombolytic drugs:
= Streptokinase
= Anisoylated plasminogen-streptokinase
activator complex (antistreplase)
= Tissue plasminogen activator (t-PA)
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Anticoagulant, Fibrinolytic and Anti-
platelet Drugs
Used to treat or prevent thromboembolism
In a normal individual, blood remains fluid in vessels
will clot when a vascular injury occurs
If an intravascular thrombus is formed, it is promptlydissolved by afibrinolytic system
If bleeding occurs, there is spontaneous arrest ofbleeding from a damaged blood vessel
(Haemostasis)
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Haemostasis and Thrombosis
Sequence of events in
haemostasis:
Vasospasm platelet adhesion
platelet aggregation
white thrombus red
thrombus
In case of thrombosis:
Arteries: mainly white thrombi
(ischemia)
Low-pressure veins
(particularly if stasis): mainly
red thrombi, often with long
tailsemboli (e.g., in lung)
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Fibrinolysis
Achieved through the conversion of
inactiveplasminogen to activeplasmin
Plasmin remodels the thrombus and
prevents its excessive growth
Via proteolytic digestion of fibrin
Injured cells release tissue plasminogen
activator - tPA
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Drugs to Be Discussed
Anticoagulant drugs:
Heparin, low molecular weight heparins
Oral anticoagulants: warfarin
Fibrinolytic drugs: streptokinase, tissue plasminogenactivator
Anti-platelet drugs: aspirin, clopidogrel, Abciximab
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Standard or high molecular
weight heparin Obtained from mast-cell rich tissues in animals
just for curiosity: porcine intestinal mucosa or bovine lung
Despite the differences in composition among
commercial preparations, biological activity is similar Doses are expressed in units of activity, USP units
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Contraindication for thrombolytics:
Recovering from recent surgery
With active bleeding from stomach ulcers
With very high blood pressure With a history of a recent stroke, head injury,
or a bleeding disorder
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Medications To Reduce The Work Load Of
The Heart
decrease the work load===oxygen needsdecrease
Drugs that decrease the work load of the heart
include: Nitrates
Beta blockers
Angiotensin converting enzyme (ACE) inhibitors
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Medications To Prevent And Treat
Complications
including:
=Aspirin
=Antiarrhythmic agents=Drugs for heart failure
=Anticoagulants or blood thinners
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Digoxin
increases the strength of heart muscle
contractions and is useful in the treatment of
heart failure ----- inotropic action (+) Because digoxin also slows conduction of the
heart's electrical impulses, it is also useful in
controlling atrial fibrillation, atrial flutter, and
atrial tachycardia -- chronotropic action (+)
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ACE-Inhibitor ,bergunakah pada CAD tanpa heart failure ?
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Warfarin -- Nursing Implications
Many herbal products have potential
interactionsincreased bleeding may
occur
Capsicum pepper
Garlic
Ginger Gingko
Ginseng
Feverfew
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Drugs for Heart failure
Diuretics, which reduce the blood volume by
causing the kidneys to get rid of more sodium
and water
Nitrates
ACE inhibitors
http://www.ehealthmd.com/library/heartattack/HA_meds.htmlhttp://www.ehealthmd.com/library/heartattack/HA_meds.htmlhttp://www.ehealthmd.com/library/heartattack/HA_meds.htmlhttp://www.ehealthmd.com/library/heartattack/HA_meds.htmlRecommended