DRUGS USED IN ANGINAPECTORIS & MYOCARDIAL INFARCTION WIWIK RAHAYU, dr., M.Kes Depart.of.Pharmacology & Therapy Faculty Of Medicine – Riau University
ANGINA PECTORISA syndrome of inadequate oxygen delivery tothe myocardium relative to the oxygenrequirement of this tissue• Symptom Severe, transient retrosternal pain radiated to the left arm, back or jaw• Duration: 0,5 – 30 minute• ECG:
TYPE OF ANGINA PECTORIS1. CLASSIC ANGINA – Atherosklerosis – Precipitating factor (+)2. PRINZMETALS – Vasospasm – Precipitating factor (-)3. UNSTABLE A rapid increase in frequency and intensity of anginal pain occurs, which is thought to herald imminent myocardial infection.
PharmacokineticsDrug Absorption Bioavailability Active Half Onset Peak Metabolites Life of Effect (hr) Action after after oral Oral Dosing DosingVerapamil >90% 10%-35% + 5 <1hr 1-2hrNifedipine >90% 60%-70% - 2 <20min 30min (2-3 min)* <1hrDiltiazem >80% 40% + 3,5 2-3hr
CLINICAL PROBLEMS AND SIDE EFFECTSVERAPAMIL Problems in 8% to 10% of patients Major Cardiodepression Moderate Hypotension AV node block Peripheral edema Minor Headache ConstipationNIFEDIPINE Problems in 17% to 20% of patients Major Hypotension Headache Peripheral edemaDILTIAZEM Problems in 2% to 5% of patients Minor Hypotension -AV Node Block Peripheral edema -Cardiodepression
PROPANOLOL Is the prototype β adrenergic blocker ↓Inotropic chronotropic ↓ O2 demandβ Adrenergic domotropicblocker ↓Renin → Ag → peripheral →BP ↓ resistance aldosteron ↓ Sodium, water BP ↓ retention
INDICATIONI. ANGINA PECTORIS For Chronic management of stable anginaIII. MYOCARDIAL INFARCTION Reduces infarct size and has tens recovery Reduce the incidence f sudden arrhythmic death after myocardial infarctVI. HYPERTENSIONVII. ARRYTHMIAVIII.MIGRAINEIX. GLAUCOMAX. HYPERTHYROIDISM