Anti Anginal and Infarkmyocard

Dosen Pengampu : Novia sinata, M.Si, Apt

By : Nurul Sri Barokah (1800033)

Class Of DIII III A
 Antianginal
O Anginal is a compilation of the heart from the
blood supply and angina itself can develop into a
heart attack.
O In general, there are 2 angina namely stable and
unstable.

Angina stable is taking place in less

than 20 minutes and is repaired by
itself.

In contrast to longer unstable angina,

more than 20 minutes is better for a
heart attack.
O Stable angina is caused by certain triggers such
as strenuous exercise, stress, digestive
problems, or other medical conditions that
encourage the heart to work harder. Cold
weather can also be one of the triggers of
symptoms of angina. Chest pain will usually
improve within 5 minutes after resting or taking
medication.

O Unstable angina is chest pain that is felt without

a clear initial cause and usually does not
improve after resting or taking medication.
O The primary cause of angina pectoris is an
imbalance between the oxygen requirement of the
heart and the oxygen supplied to it via the coronary
vessels.
O This is caused by reduced coronary blood flow, due
to narrowing of the blood vessels due to spasm and
/ or alterosklerosis process.
O2 needs are
increased →
excessive exercise
Causes of angina:
O2 supply increases
→ vascular blockage
SYMPTOMS THE EMERGENCE OF ANGINA

O Severe pain under the sternum that

radiates to the arms, shoulders, neck
or jaw area.
O Arise when walking up stairs or
exertion when after eating.
O The duration of angina pectoris is 5-
30 minutes
Images Of Coronary Arteries
Angina Drugs
Classification of Drugs
O organic nitrates
O calcium channel blockers
O β blockers
 NITRATES
Nitrates benefit patients with variant angina
by relaxing the smooth muscle of the
epicardial coronary arteries and relieving
coronary artery spasm.

Mechanism of action:
Causes vasodilation / dilation of peripheral and
coronary arteries
Effects on the heart:
Reducing oxygen, myocardial / cardiac requirements
and increasing myocardial / cardiac oxygen supply
 NITRATES

ONitroglycerin
Releases nitric oxide in smooth muscle, which activates guanylyl
cyclase and increases cGMP.
O Trade marks: Nitrokaf Retard, Glyceryl Trinitrate DBL, Nitral, NTG
O Dose:
-Oral tablets : 2.6-2.8 mg 3 times a day or 10 mg 2-3 times a day.
-Sublingual tablets :0.15–1.2 mg, placed just under the tongue.
Duration of actions is 10-30 minutes.
-Heart attack: 10-100 mcg / minute

O Side Effects:
O Great dizziness
O Passed out
O Blurred vision
O Pale and cold sweat
O Shortness of breath
O Pounding.
Example of drug
O Isosorbid dinitrat (ISDN)

O Trade marks: Isosorbide Dinitrate OGB Dexa ,

Vascardin.
O Indication: prophylaxis and treatment of
angina; left heart failure.
O Dose :
  Oral : 30-120 mg
Sublingual : 5-10 mg
O Side Effect
1. dizzy
2. Headache
3. Nausea Throw up
 Calcium channels Blocker

O calcium channel blockers also reduce peripheral

resistance and blood pressure. The mechanism
of action in is inhibition of calcium influx into
arterial smooth muscle cells.
O In general, calcium is used by arterial muscle
cells in the process of muscle contraction. This
drug serves to inhibit calcium from entering
muscle cells, so that the blood vessels will
become weak muscles.
 Example Of drug
1. Amlodipine
O Indications : Hypertension, angina pectoris.
O Trade mark : A-B Vask, Amlogal, Cardicap, Divask, Finevask,
Gensia, Gravask 5 / Gravask 10, Lupin, Opivask, Stamotens,
Theravask, Amcor, Calsivas, Cardisan, Dovask, Fulopin,
Gracivask, Lodipas, Norvask, Provask, Tensivask, Zevask

O Dose
Adults: 5 mg/day, a maximum of 10 mg/day. Elderly: start 2.5
mg/day.
O Side effects : Swelling in hands or feet, Palpitations or
fluttering in the chest; or Chest pain or severe feeling, pain
spreading to the arm or shoulder, nausea, sweating, general
feeling of pain
  

O This drugs works by suppressing the effects of the

hormone epinephrine or adrenaline, which is a hormone
that plays a role in blood flow, so that the heart beats
slower and works less, and blood pressure drops. In
addition, this drug also helps dilate blood vessels so that
blood circulation runs smoothly.
O Nonselective beta blockers: In charge of blocking beta-1
and beta-2 receptors with effects that affect the heart,
blood vessels, and respiratory tract. Types of beta
nonselective inhibitors are carvedilol, propranolol, and
thymolol.
 Type Of Beta Blockers based on beta receptors that
are inhibited and their effects on the body
1.
Selective beta blockers

Serves to inhibit beta-1 receptors with effects affecting the

heart's work, but not the respiratory tract. Types of selective
beta blockers are atenolol, betaxolol, bisoprolol, metoprolol, and
nebivolol.

2.
Nonselective beta blockers

In charge of blocking beta-1 and beta-2 receptors with effects

that affect the heart, blood vessels, and respiratory tract. Types
of beta nonselective inhibitors are carvedilol, propranolol, and
thymolol.
1. Propranolol (Non selective betha-
blockers)
Propranolol was the first β blocker shown
to be effective in hypertension and ischemic
heart disease. Propranolol has now been
largely replaced by cardioselective β
blockers such as metoprolol and atenolol.
All β-adrenoceptor–blocking agents are
useful for lowering blood pressure in mild to
moderate hypertension
O Trade marks: Farmadral ® tablets
(Fahrenheit) 10 mg, Inderal ® tablets
(Astrazeneca) 10 mg, 40 mg.
2. Atenolol (Selective betha- blockers)
O Trade marks : Betablok, Farnormin 50,
Internolol 50, Lotenac, Niften, Tenblok,
Tenormin, Tensinorm
O Indications : Angina pectoris , Hypertension
O Form of medicine : tablets
O Dose: Adults: 50-100 mg, once a day . The
maximum dose is 200 mg per day.
 Infark Myocard
Myocard Infarct or heart attack is a condition where
the death of heart cells due to blood supply to
certain areas of the heart is reduced or obstructed.

Early symptoms Cause myocard Infarct:

 Limp
 Discomfort in the chest
 Restless
 Shortness of breath
 Nausea
 Dizzy
Signs of myocardial infarction
Risk factors for myocardial
infarction
 Smoke
 Hyperkolessterolemia (blood
cholesterol levels above normal)
 Diabetes mellitus
 Hypertension
 Obesity
 Stress
 Lack of exercise
 Consuming less fruits and vegetables
 Diagnose
O Some checks that can be done to help establish
the diagnosis include:
Laboratory blood tests. Components
examined include troponin levels,
creatinine kinase (CK), myoglobin, blood
lipid levels, markers of inflammation,
and also complete blood tests.

Electrocardiography (ECG). ECG

functions to record electrical activity in
the heart. Is the main examination that
is important to do to establish a
diagnosis of heart attack.

Cardiac imaging. X-ray examination or

CT scan of the heart can be done after
the patient's condition is stable.
Classification of drugs
O 
 ACE inhibitor

To dilate blood vessels and reduce blood

pressure, thereby reducing the burden on the
heart. With this drug, blood vessels become
dilated, so the pressure on the blood vessels
decreases, so does the amount of fluid
flowing in the blood vessels.
1. Ramipril
O Trade marks : Cardace, Decapril, Triatec
O Dose :
The initial dose is 2.5 mg, twice a day. The dose can be
increased up to 5 mg, 2 times a day, after 2 days of
taking the medicine. The maintenance dose is 2.5-5 mg,
2 times a day.
O Mechanism of Actions:
This drug works by inhibiting the hormone that converts
angiotensin I to angiotensin II. Angiotensin II is a
substance that makes blood vessels narrow. With the
formation of angiotensin II, the muscles of the blood
vessels weaken and the blood vessels will be wider, so
that blood can flow more smoothly and blood pressure
drops. With normal blood pressure, complications like
stroke, heart attack, and kidney failure can be prevented.
 Antiplatelet drugs

O Such as aspirin and clopidogrel, to prevent blood clots, so that

blood can still flow through narrowed blood vessels, so that blood
clots do not form.

1. Aspirin
O Trade marks : Ascardia, Aspilets, Farmasal, Miniaspi 80,
Thrombo Aspilets
O Dose : 160-325 mg a few minutes after symptoms.
O Side Effects :
Bronchospasm; gastrointestinal bleeding (sometimes severe), as
well as other bleeding (eg sub-conjunctival).
 Blood Vessel Dilation
(Vasodilator)
O This drug works by affecting the muscles in the walls of arteries and
veins. Vasodilators reduce the tension in the muscle walls of blood
vessels, so that the space in the blood vessels does not narrow.

O This will make it easier for the body to drain oxygenated blood
throughout the body, including the heart muscle, and suppress the
potential for blood flow back to the heart's chamber.

1. Nitroglycerin
O Dose:
-Oral tablets : 2.6-2.8 mg 3 times a day or 10 mg 2-3 times a day.
-Sublingual tablets :0.15–1.2 mg, placed just under the tongue.
Duration of actions is 10-30 minutes.
-Heart attack: 10-100 mcg / minute
Statin (Cholestrol Drug)
O Atorvastatin

O Mechanism Of Actions :
reduce cholesterol levels with reduce LDL levels that
are too high in the blood
O Trade marks : Atorvastatin, Atofar, Atorwin,
Cholestor, Actalipid
O Dose : 10- 20 mg/d, The maximum dose is 80 mg/d.
O Side Effects :
 Sore throat
 Joint pain
 Pain in the arm or leg
 Diarrhea
 Betha Blockres
O Bisoprolol

O Mechanism of Actions :
Bisoprolol works by reducing the frequency of heartbeats and
heart muscle pressure when contracting. That way, the heart's
burden in pumping blood throughout the body can be reduced.
With a fall in blood pressure, strokes and heart attacks can be
prevented.
O Trade marks : Beta-One, Bipro, Carbisol, Concor, Hapsen
O Side Effects :
 Bradycardia
 Diarrhea
 Respiratory tract infections
 Hard to breathe.
O Dose: 1,25-10 mg/d. The maximum dose is 20 mg/d.
 Anticoagulant drugs
O Mechanism of Actions
To inhibit the formation of fibrin, and is used
prophylactically to reduce the incidence of
thromboembolism especially in veins.
O To prevent blood clots from occurring again

1. Enoxaparin
O Trade marks : Levenox
O Dose : 30 mg (IV) with 1 mg / kgBB (Sc)