21042012pleno pakar pc blok cvs

7/29/2019 21042012Pleno Pakar Pc Blok CVS

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21042012Pleno pakar Pc Blok CVS

Dr.Datten Bangun MSc,SpFK

Dep.Farmakologi & TherapeutikFak.Kedokteran USU ,MEDAN


2/24

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


3/24

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.html


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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
http://www.ehealthmd.com/library/heartattack/HA_meds.htmlhttp://www.ehealthmd.com/library/heartattack/HA_meds.html


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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.html

21042012pleno pakar pc blok cvs

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