Beruflich Dokumente
Kultur Dokumente
kolinergik, penyelamat
hidup, dan anti aritmia
Gama Natakusumawati
I1111017
Causes of arrhythmias
Abnormal
Antiaritmia
Class IB drug
Lidocaine
Actions: Lidocaine, a local anesthetic,
shortens Phase 3 repolarization and
decreases the duration of the action
potential.
Therapeutic uses: Lidocaine is useful in
treating ventricular arrhythmias arising
during myocardial ischemia, such as
during a myocardial infarction
Mexiletine
These Class IB drugs have actions similar to those
of lidocaine, and they can be administered orally.
used for chronic treatment of ventricular
arrhythmias associated with previous myocardial
infarction.
Tocainide
Used for treatment of ventricular
tachyarrhythmias.
Pulmonary toxicity, which may lead to pulmonary
fibrosis.
Class II Antiarrhythmic
Drugs
Class II agents are -adrenergic
antagonists. These drugs diminish Phase 4
depolarization, thus depressing
automaticity, prolonging AV conduction,
and heart rate and contractility.
Class II agents are useful in treating
tachyarrhythmias caused bysympathetic
activity. Also used for atrial flutter and
fibrillation and for AV-nodal reentrant
tachycardia.
Propranolol
Reduces the incidence of sudden
arrhythmic death after myocardial
infarction (the most common cause of
death in this group of patients).
The mortality rate in the first year
after a heart attack is significantly
reduced by propranolol, partly
because of its ability to prevent
ventricular arrhythmias.
Amiodarone
Actions:
contains iodine and is related structurally to thyroxine.
It has complex effects, showing Class I, II, III, and IV
actions. Its dominant effect is prolongation of the action
potential duration and the refractory period.
Amiodarone has antianginal as well as antiarrhythmic
activity.
Therapeutic uses:
Amiodarone is effective in the treatment of severe
refractory supraventricular and ventricular
tachyarrhythmias.
Despite its side-effect profile, amiodarone is the most
commonly employed antiarrhythmic
Adverse effects:
Some of the more common effects include
interstitial pulmonary fibrosis, gastrointestinal
tract intolerance, tremor, ataxia, dizziness,
hyper- or hypothyroidism, liver toxicity,
photosensitivity, neuropathy, muscle weakness,
and blue skin discoloration caused by iodine
accumulation in the skin.
recent clinical trials have shown that
amiodarone does not reduce the incidence of
sudden death or prolong survival in patients
with congestive heart failure
Sotalol
A class III antiarrhythmic agent, also has
potent nonselective Beta-blocker activity. It
is well established that beta blockers reduce
mortality associated with acute myocardial
infarction.
Actions: blocks a rapid outward potassium
current, known as the delayed rectifier. This
blockade prolongs both repolarization and
duration of the action potential, thus
lengthening the effective refractory period.
Therapeutic uses:
used for long-term therapy to decrease the rate of
sudden death following an acute myocardial infarction.
have a modest ability to suppress ectopic beats and to
reduce myocardial oxygen demand.
strong antifibrillatory effects, particularly in the
ischemic myocardium.
Sotalol was more effective in preventing recurrence of
arrhythmia and in decreasing mortality than imipramine,
mexiletine, procainamide, propafenone, and quinidine in
patients with sustained ventricular tachycardia
Adverse effects:
This drug also has the lowest rate of
acute or long-term adverse effects
prolong the QT interval
the syndrome of torsade de pointes
is a serious potential adverse effect,
typically seen in three to four percent
of patients
Class IV Antiarrhythmic
Drugs
Class IV drugs are calcium-channel blockers .
They decrease the inward current carried by
calcium, resulting in a decreased rate of Phase 4
spontaneous depolarization.
They also slow conduction in tissues that are
dependent on calcium currents, such as the AV
node.
Although voltage-sensitive calcium channels
occur in many different tissues, the major effect
of calcium-channel blockers is on vascular
smooth muscle and the heart.
Therapeutic uses:
Verapamil and diltiazem are more effective against
atrial than against ventricular arrhythmias. They are
useful in treating reentrant supraventricular
tachycardia and in reducing the ventricular rate in
atrial flutter and fibrillation. In addition, these drugs
are used to treat hypertension and angina.
Pharmacokinetics:
Verapamil and diltiazem are absorbed after oral
administration.
Verapamil is extensively metabolized by the liver;
thus, care should be taken when administering this
drug to patients with hepatic dysfunction.
Adverse effects:
Verapamil and diltiazem have
negative inotropic properties and,
therefore, may be contraindicated in
patients with preexisting depressed
cardiac function.
Both drugs can also produce a
decrease in blood pressure because of
peripheral vasodilation an effect that
is actually beneficial in treating
Adenosine
Adenosine is a naturally occurring nucleoside,
but at high doses, the drug decreases
conduction velocity, prolongs the refractory
period, and decreases automaticity in the AV
node.
Intravenous adenosine is the drug of choice for
abolishing acute supraventricular tachycardia.
It has low toxicity but causes flushing, chest
pain, and hypotension. Adenosine has an
extremely short duration of action
(approximately 15 seconds).
OBAT ANTIKOLINERGIK
Reseptor kolinergik
(kolinoseptor)
Berdasarkan
perbedaan
afinitas
terhadap zat
yang mampu
meniru
asetilkolin
(ACh)
R.
Muskarinik
R. Nikotinik
Reseptor Muskarinik
Afinitas kuat terhadap muskarin
Afinitas lemah terhadap nikotin
Terdiri dari subkelas : M1, M2, M3, M4, M5
Terdapat dlm ganglia SS perifer dan organ
Reseptor Nikotinik
Afinitas kuat terhadap nikotin
Afinitas lemah terhadap muskarin
Terdpt di SSP, medula adrenalis, ganglia
Nama lain
Lokasi
Mekanisme
M1
M1a
Saraf
M2
M2a; M2 jantung
Jantung, saraf,
otot polos
M2b; m2 kelenjar
Kelenjar, otot
polos, endotel
SSP ??
SSP ??
NM
Sambungan
neuromuskular
otot skelet
NN
Tipe neuronal,
reseptor ganglion
Badan sel
pascaganglion
M3
M4
M5
a. Obat antimuskarinik
Obat golongan ini seperti atropin dan
ipratropium, skopolamin
ATROPIN
Golongan antikolinergik
INDIKASI:
Asystole/PEA (2nd line setelah adrenalin)
Unstable bradikardia
Keracunan kolinergik (organofosfat)
SEDIAAN:
Ampul 0,25 mg/ 1 mL
DOSIS:
Asistol/PEA : 1 mg IV flush, diulang 3 5 menit (maks 3 mg)
2 3 mg dilarutkan dalam 10 ml NS
Bradikardia : 0,5 mg IV flush, diulang tiap 3 5 menit (maks
3 mg)
Keracunan organofosfat: 1-2 mg, diulang tiap 2-5 menit
sampai terdapat tanda atropinisasi
EFEK:
Meningkatkan konduksi HR naik
Menurunkan sekresi klj antikolinergik
PERHATIAN:
Dapat memperburuk iskemia miokard
(takikardi, palpitasi)
Menyebabkan bradikardia paradoksal (< 0,5
mg)
Hipertensi, kejang
Tidak berguna untuk blok AV node derajat 2
tipe II dan derajat 3
b. Obat penyekat
neuromuskular
Obat ini menyekat transmisi kolinergik antara
ADRENALIN (EPINEPHRIN).
INDIKASI:
VF, Pulseless VT, PEA, Asystole
Mengatasi gangguan sirkulasi (Syok distributif)
menghilangkan bronchospasme
SEDIAAN:
ampul 1:1000 (1 mg/1 ml)/ ampul 1:10000 (0,1 mg / 1 ml)
Rute: IV flush, ET (2-3 x dosis IV), Infusion 1 mg/500 ml
D5%/NS (2 ug/mL)
DOSIS:
CPR: 1 mg IV flush (diikuti 10 ml NS), diulang 3-5 menit
2- 2,5 mg ET (dilarutkan dlm 10 ml NS)
Anafilaktik : 0,5 mg SC/IM
Shock : infusion 1 ug/menit, titrasi sampai max 10 ug/mnt
Bronkodilator : 0,3 mg SC (syarat kondisi jantung bagus)
DOPAMINE
INDIKASI:
Shock (refrakter terhadap pemberian cairan)
obat pilihan kedua untuk bradikardia simtomatis
(setelah atropin)
Hipotensi (TDS < 70 mmHg)
SEDIAAN: Ampul 200 mg/ 5 mL
DOSIS:
2 5 ug/kg/menit meningkatkan renal blood
flow
5 10 ug/kg/mnt meningkatkan kontraksi
jantung
> 10 ug/kg/ mnt konstriksi sistemik
PERHATIAN:
Setelah target tercapai, turunkan
bertahap (tapering)
Jangan mencampur/melarutkan
dengan natrium bikarbonat, lakukan
pengenceran dengan D5%, D5 1/2
NS, D10 0,18 NS; RL
Diberikan dengan syringe pump atau
infusion pump, harus selalu drip,
bukan IV bolus
Bisa menyebabkan takiaritmia,
DOBUTAMIN
INDIKASI:
Dipertimbangkan untuk kasus pump
problems (gagal jantung kongestif,
sembab paru/congestive pulmonum)
dengan TDS 70 100 mmHg dan
tidak ada tanda-tanda syok
SEDIAAN: Ampul 250 mg/ 10 mL
DOSIS:
2 20 g/kg per menit, titrasi
sehingga HR tidak sampai meningkat
PERHATIAN:
Cegah pemberian pada TDS < 100
mmHg dan ada tanda-tanda syok
Menyebabkan takiaritmia
Tidak boleh mencampur dengan
natrium bikarbonat
MORFIN
INDIKASI:
Chest pain dengan Acute Coronary Syndrome (ACS)
yang tak respon dengan nitrat
Edema paru akut kardiogenik (bila TD adekuat)
SEDIAAN: Ampul 10 mg/ 1 mL
DOSIS:
Dosis inisial : 2 4 mg IV dalam 1 5 menit, setiap 5
sampai 30 menit
Dosis ulangan : 2 8 mg pada interval 5 sampai 15
menit
Masukkan pelan-pelan dan titrasi sampai tercapai efek
PERHATIAN
Tidak untuk infark inferior
Bisa menyebabkan depresi napas
Menyebabkan hipotensi (pada pasien
dengan deplesi volume cairan)
Gunakan dengan hati-hati/perhatian
penuh pada kasus infark ventrikel kanan
Antidotum : nalokson (0,4 2 mg IV)
ALHAMDULILLAH.