225093630 herbesser injeksi slide

8/12/2019 225093630 Herbesser Injeksi Slide

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Humongous Insurance

MANFAAT KLINIS DILTIAZEM INTRAVENA DALAMPENANGANAN HIPERTENSI EMERGENCY

PT TANABE INDONESIA


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DefinisiHYPERTENSIVE RISISSuatu keadaan hipertensi berat, umumnya ditandai dengan SBP > 220mm Hg dan/atau DBP > 120 mm Hg.(JNC-VII, 2003)

1. HYPERTENSIVE EMERGENCIES

Hipertensi berat disertai dengan disfungsi organ target

yang akut, seperti iskemik di koroner, stroke, perdarahan

intraserebral, udema di pulmoner, atau gagal ginjal akut.

2. HYPERTENSIVE URGENCIES

Hipertensi berat tanpa disertai adanya kerusakan organ target.

Colhum DA. Oparil S, New Engl. J. Med, 323 : 1177, 1990


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- Accelerated malignant hypertension

- Hypertensive encephalopathy

- Intracerebral / Subarachnoid hemorrhage- Acute aortic dissection

- Acute left ventricular failure

- Acute myocardial infarction

- Acute glomerulonephritis

- Eclampsia

- Severe epistaxis

- Perioperative hypertension, etc

DBP >120 mmHg

URGENCYTD dalam waktu < 24 hours EMERGENCYTD dalam waktu < 1 hours( PARENTERAL / ORAL ) ( PARENTERAL )

1. KAPLAN NM., Lancet 344:1335,1994

2. KAPLAN NM., 8thedition., 2002 p : 339-40

Hypertensive Crisis


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Terapi Hipertensi EmergencyPasien harus dirawat inap di Rumah Sakit

Tekanan darah harus diturunkan:

-Secara cepat

-Gradual

-Obat yang diberikan harus I.V.


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Sediaan Antihipertensi Intravenayang Ideal

Mampu mengendalikan dan mengontrolpenurunan tekanan darah

Minimal resiko akan timbulnya hipotensiCepat dan dapat diprediksi dalam menurunkan

tekanan darahEfek samping yang minimal


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DILTIAZEM I.V. ( HERBESSER Injection )

Bermanfaat untuk pasien hypertensive emergency danurgency.

Termasuk ke dalam golongan Non-dihydropyridinecalcium channel blockers.

Dose-dependent :Onset kerja dapat diprediksi

Menurunkan TD dengan cepat.Tidak ada efek rebound pada saat penghentian

Adverse effect : hypotension, headache, flushing.

Memiliki kelebihan sebagai antiischemic dan antiarrhythmic

OBAT YANG UMUM DIGUNAKAN PADAHYPERTENSIVE EMERGENCY


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Calcium Channel Blockers

Nicardipine

(dihydropyridine)

Diltiazem

(benzothiazepine)

Peripheral

Vasodilation1+++++ +++

CoronaryVasodilation2

+++++ +++

Suppression

of SA Node2 + +++++

Suppression

of AV Node2 0 ++++

Suppression

of Cardiac Contractility2 0 ++

1. Frishman WH, et al. Med Clin North Am. 1988;72:523-547.

2. Adapted from Goodman and Gilmans: The Pharmacologic Basis of Therapeutics. 9th ed. 2001.


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NICARDIPINE and DILTIAZEM

NICARDIPINE DILTIAZEM

Target organ Arteriole (ca

Channel)

Arteriole (ca

Channel)Clinical effect Vasodilatation :

BP decreased

Vasodilatation :

BP decreased

Heart Rate


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Diltiazem and Nicardipine on HR ofHypertensive emergency patients

Nicardivine I.V.Diltiazem

I.V

< 60 60 - 80 > 80

Heart Rate (beat/minute)


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JNC VII

Recommendation:

The Initial Goal of Therapy in Hypertensive

Emergency Is to Reduce MABP by No More

Than 25% (within minute to 1 hour), then if

stable, to 160/100-110 within the next 2-6

hours.


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MABP

MABP

50

70

90

110

130

150

170

29 Severe Hypertensive Patients After 1 hr time evaluation

Average infussion Rate: 11 g/kg/mnt.

Result:

MABP

MABP

50

60

70

80

90

100

110

120

130

140

150

22

%

After treatment:

SBP: 154.0

DBP: 83.3MABP: 113.4

Pretreatment:

SBP: 205.6-

DBP:115.8MABP: 145.7

Onoyama K., et al., Current Therapeutic Research, Vol. 43, No. 3. March 1988.

27

%

11 Hypertensive Crisis Patients Average time evaluation 3.5 hr

Infussion Dossage: 5-40 g/kg/mnt.

Result:

After treatment:

Avg: SBP: 170-

DBP: 95MABP: 120

Pretreatment:

Avg: SBP: 224-

DBP:136MABP: 165.7

Onoyama K., et al., Current Therapeutic Research, Vol. 42, No. 6. December 1987.

Herbesser Inj Drip I V Fulfill theJNC VII Recommendation:


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Di Indonesia Herbesser Injeksi

direkomendasikan dalam:

Konsensus Penanggulangan Krisis

Hipertensi (InaSH 2008).

Penatalaksanaan Hipertensi pada Stroke

Akut. (Guideline Stroke PERDOSSI 2007, BAB VI hal 47)


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Guideline Management of

Hypertension Emergency

Japan Society of Hypertension (JSH) 2009

Di Jepang Herbesser Injeksi

direkomendasikan dalam


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Respon Pasien Diltiazem I V1. Tachyarrhythmia / PSVT / AF85% success

2. Unstable angina, 80% success

diawali 5-15 mcg/kg/min drip

3. Hypertensive emergency 94-100% successdiawali dosis 10 mg iv dilanjutkan dengan drip

infus 5-15 mcg/kg/min untuk mencapai target TD

Drug insert


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DESCRIPTIONHERBESSER Injection 50 mg merupakan sediaan injeksi yang

dilarutkan dengan larutan fisiologis atau glukosa sebelum

digunakan.

INDICATION

1. Tachyarrhythmia ( Supraventricular )

2. Perioperative Hypertension

3. Hypertensive emergency

4. Unstable Angina

HERBESSER Injection


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The Intravenous Ca-blocker

To Lower Blood Pressure

Faster

HERBESSER-Injection (Diltiazem HCl)


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HERBESSER Injection

CONTRAINDICATION1. Patients with severe hypotension

Patients with 2nd or 3rddegree of AV-block or sick sinus

syndrome ( sinus bradycardia less than 50 beats / minute )

2. Patients with severe congestive heart failure

3. Patients with severe cardiomyopathy4. Patients with history of Hypersensitivity to diltiazem

5. Pregnant women or woman who may possibly be pregnant.

ADVERSE REACTION

Bradycardia 1.1 % 1st

degree AV block 0.4 %Hypotension 0.7 % 2nddegree AV block 0.3 %

PRESENTATIONHERBESSERInjection 50 mg Boxes of 50 mg x 10 ampoules


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