obat gagal jantung
TRANSCRIPT
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GAGAL JANTUNG :
Suatu kondisi dimana jantung tidak mampu
memompa darah yang cukup untuk kebutuhan
metabolisme jaringan
Gejala :
Perfusi jaringan tidak adekuat
( lemah, sesak napas)
Peingkatan tekanan pengisian intrakardial
(sesak napas bila berdiri (orthopnea), paroxysmal
nocturnal dyspnea, edema)
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Penyebab :
ACUTE : infark miokard
CHRONIC : hypertension
penyakit arteri koroner
penyakit katup jantung
anemia
dll
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Remodelling
Carotid
sinus firing
aliran darah ginjal
Sympathetic
discharge
Force
Rate
Preload
Angiotensin II
pelepasan Renin
Afterload
Cardiac output
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Angiotensin I
Angiotensin II
AldosteroneVasoconstriction
resistensi Perifer Retensi Na & air
volume darah
Aliran darah balik vena
Preload
Angiotensinogen
Afterload
Renin
ACE
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Strategi Pengobatan
Mengeluarkan Na dan air diuretik
Meningkatkan kontraktilitas jatung positive inotropic drugs
Menurunkan preload atau afterload vasodilator
• Menurunkan afterload & mengeluarkan Na dan air» ACE Inhibitors
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DIURETIK
LOOP D.
THIAZIDE D.
POTASSIUM
SPARING D.
Furosemide
Hydrochlorothiazide
Spironolactone
(aldosterone antagonist)
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OBAT INOTROPIC POSITIF
DIGITALIS
BETA AGONIS
DOPAMINE
DOBUTAMINE
PDE INHIBITORS
AMRINONE
MILRINONE
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Vasodilator yang digunakan pada
CHF
OBAT TEMPAT KERJA/EFEK
Hydralazine Arteriol
Nitrates Vena
Nitroprusside Arteriol & Vena
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Gagal jantung akut
• Furosemide (loop diuretic)
• Positive inotropic agent (prompt acting)• Beta agonist
• Phosphodiesterase inhibitor
• Vasodilator
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Gagal jantung kronik
Diuretic
ACE inhibitors
Beta blocker (jika dapat ditoleransi)
Digitalis (jika disfungsi sistolik menonjol
arau fibrilasi artrial)
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Jika tidak toleransi ACE Inhibitors
Hydralazine + Nitrate
Angiotensin Receptor Blockers
(ARB)
ATAU
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DIURETIC
(kecuali spironolactone)
DIGITALIS
+ KCl
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GLICOSIDA JANTUNG
(DIGITALIS)
POSITIVE INOTROPIC EFFECT CHF
AV CONDUCTION VELOCITY ATRIAL
FIBRILATION
AV REFRACTORY PERIODE ATRIAL
FLUTTER
EFFEK :
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DIGOKSIN
Eliminasi utama ginjal
Quinidin menurunkan kliren digoksin
Indeks Terapi sempit/rendah
Hipokalemia (diuretic), hipomagnesemia
(muntah) , hipercalcemia digitalis
toxicity