OBAT KARDIOVASKULER

CARIDOVASCULAR DRUGS: Hypertension

• Defined as sustained elevated arterial blood pressure** Greater

than or equal to 140/90**
• BP = Co* tahanan perifer: CO diregulasi oleh jantung, tahanan
perifer diregulasi pemb.drh

Treatment for Hypertension

• 1. Life style—Like what changes???
**Add in medication:
• 2. Diuretics
• 3. Centrally acting antiadrenergic agents
• 4. Peripherally acting antiadrenergic agents (beta dan alfa
antagonis)
• 5. Vasodilators
• 6. Angiotensin-Converting Enzyme (ACE) Inhibitor
• 7. Angiotensin II Antagonists
• 8. Calcium Channel Blocking Agents
 What is happening???
Area of heart muscle dies from insufficient O2

Reasons for MI??

 1. Decrease flow of O2 to heart muscle

-- thrombus formation, embolism

 2. Increased demand for O2 by myocardium

--Stress, heavy exertion, abrupt increase in BP

 1. Aspirin : menghambat terbentuknya trombus
 2. Nitroglycerin : vasodilatasi arteri dan vena  meningkatkan
supply oksigen dan mengurangi beban jantung
 3. IV Morphine
 4. Beta-Blocker : beta adrenergik antagonismengurangi kerja
jantung
 5. Angiotensin Corveritng Enzyme inhibitor : menghambat
sintesa angiotensin 2 sehingga vasokonstriksi (terutama di
ginjal) berkurang/tidak terjadi
 6. Lidocaine: menghambat masuknya natrium ke dalam sel 
depolarisasi  tidak terjadi kontraksi jantung
 7. Calcium Channel Blocker: menghambat masuknya kalsium ke
dalam sel  tidak terjadi kontraksi pemb.drh dan jantung
 What is happening in the heart to cause arrhythmias???
something causes spontaneous electrical discharges anywhere in the
heart

Treatments for arrhythmias??

 --No treatment for some
 --Cardioversion --Pacemakers
 --Drugs therapy:
quinidine (Duraquin, Cardioquin)
procainamide (Procan)
amiodarone (Cordarone)
verapamil (Calan)
lidocaine (Xylocaine)
propranolol (Inderol)
atenolol (Tenormin)
diltiazem (Cardizem)
3 things happen:
 1. Cardiac distention result from inability of ventricles to pump
all blood
 2. Cardiac hypertrophy—from prolonged stretching

 3. Sodium and water retention—partly due to decreased blood

to kidneys

Inotropik positip (obat yang meningkatkan kontraksi jantung)

 CARDIAC GLYCOSIDES (DIGOXIN & DIGITOXIN)

 Inamrinone Lactate (Inocor) & Milrinone Lactate (Primacor)

 Signs and Symptoms of Heart Failure
◦ Shortness of Breath (dyspnea)
 WHY?
 Blood “backs up” in the pulmonary veins because the
heart can’t keep up with the supply an fluid leaks into
the lungs
 SYMPTOMS
 Dyspnea on exertion or at rest
 Difficulty breathing when lying flat
 Waking up short of breath
 Signs and Symptoms of Heart Failure
◦ Persistent Cough or Wheezing
 WHY?
 Fluid “backs up” in the lungs
 SYMPTOMS
 Coughing that produces white or pink blood-tinged
sputum
 Signs and Symptoms of Heart Failure
◦ Edema
 WHY?
 Decreased blood flow out of the weak heart
 Blood returning to the heart from the veins “backs up”
causing fluid to build up in tissues
 SYMPTOMS
 Swelling in feet, ankles, legs or abdomen
 Weight gain
 Signs and Symptoms of Heart Failure
◦ Tiredness, fatigue
 WHY?
 Heart can’t pump enough blood to meet needs of
bodies tissues
 Body diverts blood away from less vital organs
(muscles in limbs) and sends it to the heart and brain
 SYMPTOMS
 Constant tired feeling
 Difficulty with everyday activities
 Signs and Symptoms of Heart Failure
◦ Lack of appetite/ Nausea
 WHY?
 The digestive system receives less blood causing
problems with digestion
 SYMPTOMS
 Feeling of being full or sick to your stomach
 Signs and Symptoms of Heart Failure
◦ Confusion/ Impaired thinking
 WHY?
 Changing levels of substances in the blood
(sodium) can cause confusion
 SYMPTOMS
 Memory loss or feeling of disorientation
 Relative or caregiver may notice this first
 Signs and Symptoms of Heart Failure
◦ Increased heart rate
 WHY?
 The heart beats faster to “make up for” the loss in
pumping function
 SYMPTOMS
 Heart palpitations
 May feel like the heart is racing or throbbing
  New York Heart Association (NYHA)
Functional Classification
Class % of Symptoms
patients
I 35% No symptoms or limitations in ordinary physical
activity
II 35% Mild symptoms and slight limitation during
ordinary activity
III 25% Marked limitation in activity even during minimal
activity. Comfortable only at rest
IV 5% Severe limitation. Experiences symptoms even at
rest
 Digitalis Avoid taking with milk and high fiber foods,
which reduce absorption, increases potassium loss.

 Large amounts of oatmeal and other high-fiber cereals

should not be eaten when taking digoxin. The fiber can
interfere with the absorption of the drug, making the act of
swallowing the pill a waste of time.
 However, don't stop eating your cereal right away,
because that could cause digoxin levels in your system to
soar to toxic levels. A professional should make the dietary
changes after carefully examining the digoxin levels.
 People taking digoxin should avoid Black licorice (which
contains the ingredient glycyrhizin). Together, they can produce
irregular heart rhythms and cardiac arrest; licorice and diuretics
will produce dangerously low potassium levels, putting a patient
at risk for numbing weakness, muscle pain and even paralysis.
Licorice can also interact with blood pressure medication or any
calcium channel blockers.

 Do not drink herbal teas two hours before or after taking

digoxin.
 ACE inhibitorsTake on an empty stomach to improve the
absorption of the drugs.
 Alpha blockers Take with liquid or food to avoid excessive
drop in blood pressure.
 Beta blockers Take on an empty stomach; food, especially
meat, increases the drug's effects and can cause dizziness and
low blood pressure.
 Diuretics Increase the risk of potassium deficiency.
 Potassium sparing diuretics Unless a doctor advises
otherwise, don't take diuretics with potassium supplements or
salt substitutes, which can cause potassium overload.
 Thiazide diuretics  Increase the reaction to MSG.
 Antiarrhythmic drugsAvoid caffeine, which increases the risk
of irregular heartbeat.
 Grapefruit juice interacts with calcium channel blockers
(including Calan, Procardia, Nifedipine, and Verapamil),
cholesterol control medications, some psychiatric medications,
estrogen, oral contraceptives and many allergy medications
 Many different types; eg:
◦ Furosemide (Lasix)
◦ triamterene (Dyazide)
 Dyazide is ‘potassium-sparing’
◦ What does this mean?
 Patients taking Triamterene should avoid
patassium-rich food
◦ Eg?
◦ Why?
 Again, different types:
◦ Captopril (Capoten), moexipril (Univasc)
 The also ↑ the amount of potassium in the
body
 So, what do you recommend?
 Also – food interferes with absorption