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Global CVD
Mortality
http://www.who.int/cardiovascular_diseases/en/ ; http://www.world-heart-federation.org/cardiovascular-health/global-facts-map/
RISKESDAS 2013
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Acute Coronary
Syndrome
Acute coronary syndrome (ACS) refers to a
spectrum of clinical presentations ranging from
those for ST-segment elevation myocardial
infarction (STEMI) to presentations found in non
ST-segment elevation myocardial infarction
(NSTEMI) or in unstable angina.
It is almost always associated with rupture of an
atherosclerotic plaque and partial or complete
thrombosis of the infarct-related artery.
http://emedicine.medscape.com/article/1910735-overview
Mechanism of Action
Nitroglycerine
Action of Nitrates on
Circulation
The major effect
is on the venous
capacitance
vessels, with
additional
coronary and
peripheral
arteriolar
vasodilatory
benefit
Opie LH & Horowitz JD. Nitrates and newer antianginals. In: Drugs for the Heart. 7 th ed. Saunders Elsevier.
Nitrates Mechanism
Effects of nitrates in
generating NO and
stimulating
guanylate cyclase to
cause a vasodilation
Opie LH & Horowitz JD. Nitrates and newer antianginals. In: Drugs for the Heart. 7 th ed. Saunders Elsevier.
Clinical Efficacy
Perioperative
hypertension
Varon J, Malik PE. Vascular Health and Risk Management 2008:4(3) 615627
Perioperative
nitroglycerin
ISDN was successful in treating hypertension in 63% of the events, whereas NTG had an
83% success. NTG has been found to be effective in controlling hypertension
Guidelines Nitroglycerin
ANGINA
2013 ESC guidelines on the management of stable coronary artery disease, European Heart Journal (2013) 34, 29493003
STEMI
2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, Circulation. 2013;127:e362-e425
2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, Circulation. 2013;127:e362-e425
HEART
FAILURE
2013 ACCF/AHA Guideline for the Management of Heart Failure, Circulation. 2013;128:e240-e327
2013 ACCF/AHA Guideline for the Management of Heart Failure, Circulation. 2013;128:e240-e327
Scottish Intercollegiate Guidelines Network (SIGN). Acute coronary syndromes. Edinburgh: SIGN; 2013. (SIGN publication no. 93).
[February 2013]. Available from URL: http://www.sign.ac.uk
Product Profile
Farmakokinetik
Nitroglycerin
Distribusi luas di dalam tubuh, VD: 200 L
Konsentrasi plasma terapetik 0,1-3 ng/ml
(sd 5 ng/ml)
Nitroglycerin terikat 60% protein plasma,
metabolit 1,3-glyceryl dinitrate 60%, 1,2glyceryl dinitrate 30%
Onset 1-2 menit IV
Durasi 3-5 menit,
Waktu paruh 1-4 menit
Indikasi NTG
Gagal jantung yang tidak responsif karena
infark miokard akut
Angina tidak stabil yang sulit disembuhkan
dengan beta blocker dan nitrat sublingual
Pembedahan
Mengontrol hipertensi dengan cepat selama
pembedahan jantung
Menurunkan tekanan darah dan menjaga
hipotensi yang terkontrol selama prosedur
pembedahan
Mengontrol iskemia miokard selama dan
setelah pembedahan
Dosis
Indikasi
Dosis Awal
Dosis selanjutnya
Pembedahan
25 g/menit
(untuk
mengontrol
hipertensi )
Kenaikan dosis 25
g/menit setiap 5 menit
hingga tekanan darah
stabil
Pengobatan
iskemia
miokard
perioperatif
10 g/menit
Kenaikan dosis 10
Cara Pemberian
Konsentrasi
100 g/ml, 5x10 ml ampul
NTG IV dalam 500 ml
Laju infus
Mikrotetes/menit
ml/jam
Tetes/menit
10
20
12
30
18
40
24
50
30
10
60
36
12
70
42
14
80
48
16
90
54
18
100
60
20
110
66
22
120
72
24
130
78
26
140
84
28
150
90
30
Dosis (g/menit)
Peringatan dan
Perhatian
Monitoring ketat denyut nadi dan tekanan
darah
Pasien menderita hipotiroid, penyakit
ginjal dan hati yang berat, hipotermia dan
malnutrisi
Pasien dengan tekanan desakan kapiler
paru normal atau rendah dapat menjadi
sensitif khususnya terhadap efek hipotensi
Masa kehamilan dan menyusui
Kemanan dan efikasi pada anak belum
diketahui
Efek Samping
Sistem saraf: sakit kepala, pusing
Saluran cerna: mual, muntah dan nyeri
abdomen
Jantung: hipotensi, takikardia, palpitasi,
bradikardia paradoksial
Lain-lain: diaforesis, ketakutan, kekelahan,
rasa tidak nyaman, retrosternal, kejang
otot
Interaksi Obat
Obat penurun tekanan darah seperti: beta
blocker, antagonis kalsium, vasodilator
Alkohol meningkatkan efek nitroglycerin
Efek hipontensif disebabkan oleh obatobat sbb: sidenafil, tadalafil, vardenafil,
neuroleptik dan antidepresan trisiklik
Overdosis
OD ringan: hipotensi dan takikardia
Jika tekanan sistolik turun dibawah 90
mmHg dan denyut jantung meningkat
10% dari nilai awalnya infus sebaiknya
dihentikan
Jika hipotensi menetap atau pada kasus
yang berat, diatasi dengan mengangkat
kaki dan atau memberikan obat yang
meningkatkan tekanan darah atau
menghentikan infus
Summary
FAST ACTING : Fast onset in 1
minutes
POWERFUL : Strong vasodilator
Recommended by Guidelines
Cost effective
Hypertensive emergency
Large elevations in SBP or DBP (>180
mmHg or >120 mmHg, respectively)
associated with impending or
progressive OD, such as major
neurological changes, hypertensive
encephalopathy, cerebral infarction,
intracranial haemorrhage, acute LV failure,
acute pulmonary oedema, aortic dissection,
renal failure, or eclampsia.
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NICAFER
Composition:
Each ampoule (10 ml) contains
nicardipine HCl
1 mg/ml
Indications:
Emergency treatment of acute
hypertensive crises during
surgery
Hypertensive emergencies
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