antiaritmia 2009
TRANSCRIPT
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Isnatin MiladiyahDep. Farmakologi FK UII
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Gagal Jantung
1. Menjelaskan tujuan terapi pada gagal jantung
2. Menjelaskan macam-macam obat-obat untuk gagal jantung
3. Memilih obat gagal jantung yang sesuai untuk kasus tertentu
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Gagal Jantung
• Curah jantung tidak imbang dengan kebutuhan tubuh
– kontraktilitas miokard bendungan sirkulasi darah (+ konsekuensinya)
– pacuan sistem saraf simpatis
• Tujuan terapi : gejala akibat bendungan sirkulasi kapasitas kerja & kualitas hidup harapan hidup
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Pendekatan Terapi
• Menghilangkan beban CV yg berlebih :• atasi hipertensi BB aktivitas fisik• perbaiki stenosis aorta
• Pembatasan konsumsi garam
• Terapi obat
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Tujuan Terapi Obat
Obat
hilangkan bendungan sirkulasi• inotropik (+) digitalis
pre load dan afterload• diuretik dan vasodilator
perbaiki frekuensi & irama jantung• antiaritmia
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• Glikosida alami steroid, cincin lakton, molekul heksosa (1-4 gugus)
• Gugus aktif : aglikon (gabungan steroid + cincin lakton), gugus gula menentukan kelarutan dalam air & lemak
Digitalis
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1. Kontraktilitas miokard
Efek Digitalis
Inotropik (+)
hambatan Na+K+ATPase arus Ca++ intrasel cadangan Ca++ dari
RS
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Efek Digitalis
2. Aktivitas Listrik
Serabut Purkinye
NSA
NAV
• masa potensial aksi
• masa refrakter atrium
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Efek Digitalis
Otot atrium
Otot ventrikel
NSA
NAV
Serabut konduksi
respon berbeda (efek langsung/tak langsung
Dosis terapi :• tonus vagal , simpatis Dosis tinggi :• simpatis , automatisitas
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Efek Digitalis
Dosis terapi :• tonus vagal , simpatis
• periode refrakter • kecepatan konduksi
• bradikardi sinus• masa konduksi AV • AV block
Dosis tinggi :• simpatis , automatisitas
• aritmia atrium • aritmia ventrikel
• takikardia & fibrilasi ventrikel
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• Inotropik (+) fungsi ventrikel CO vol akhir sistole isi ventrikel awal diastole pengisian tetap : vol akhir diastole
• Isi ventrikel panjang serabut , tetapi kekuatan kontraksi tetap , FDJ perbaikan sirkulasi
Efek Digitalis
• resistensi sistemik afterload fs jantung
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Efek Digitalis
Inotropik (+)
curah jantung
ukuran jantung
tekanan perifer
udem
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Tujuan Belajar
1. Menjelaskan tujuan terapi pada aritmia
2. Menyebutkan klas obat antiaritmia dan contoh obatnya
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Aritmia
• Penjalaran impuls : NSA – NAV – serabut Purkinje– ditentukan oleh permeabilitas membran
terhadap Na+, K+, Ca2+ (dalam/luar sel)
• Aritmia : – kelainan pembentukan impuls– gangguan konduksi impuls– gabungan keduanya
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Tujuan Terapi Aritmia
1. Kurangi automatisitas fokus ektopik
2. Menghentikan mekanisme reentry – kecepatan konduksi – masa refrakter
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Prinsip Terapi Aritmia
1. Identifikasi dan hilangkan faktor presipitasi
2. Tentukan tujuan/target terapi
3. Minimalkan risiko obat
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• Klas I : Na-channel blocker– Ia : perpanjangan potensial aksi
• kinidin, prokainamid, disopiramid
– Ib : pemendekan potensial aksi• lidokain, meksiletin, tokainid
– Ic : efek tidak nyata• flekainid, enkainid, propafenon
• Klas II : beta-blocker (efek simpatolitik)
Klas Antiaritmia
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• Klas III : perpanjangan periode refrakter efektif (dg perpanjangan potensial aksi) bekerja pada kanal K+– amiodaron, sotalol
• Klas IV : Ca channel blocker
Klas Antiaritmia
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