ANTIANGINA

dr. Ave Olivia Rahman, MSc.

Bagian Farmakologi FKIK UNJA
2018
 Tujuan Pembelajaran
1. Mengetahui obat yang digunakan sebagai terapi
angina dan IMA
2. Memahami mekanisme kerja obat-obat tersebut.
3. Memahami indikasi dan kontraindikasi obat-obat
tersebut
4. Mengetahui efek samping obat-obat tersebut
5. Mengetahui dosis dan cara pemakaian obat-obat
tersebut
 Preview
• Angina is not a disease. It is a symptom of an
underlying heart problem, usually coronary heart
disease.
• Angina is the main symptom of myocardial ischaemia.
• Many  types of angina :microvascular angina, stable
angina, unstable angina and variant
angina/Prinzmetal's angina.
continue..

• Myocardial ischemia occurs when the oxygen

demand of the heart exceeds the supply.
• Blood supply to the heart can become
compromised through atherosclerotic plaque
buildup and/or coronary artery spasm
 Stable Angina
• Angina symptoms are often brought on by
physical activity, an emotional upset, cold
weather or after a meal.
• The episodes usually subside after a few
minutes.
 Pathophysiology
• Decreased oxygen delivery 
Autoregulation : dilation of the myocardial
vessels .
• Coronary artery endothelium synthesize NO
(nitirc oxide) relaxation of the arterial
smooth muscle.
• Loss of endothelial layer results in less NO
 Management
• Lifestyle modification
• Drug treatment
• Revascularisation
Drug Treatment
Clinical Uses
 1. Nitrates
• Nitrates can be used for both acute attacks and for
prophylaxis
• It reduce oxygen demand through vasodilation and
reduced left ventricular preload.
• Nitrogliserin and isosorbide dinitrate (ISDN)
• Adverse effects : postural hypotension, headaches,
flushing, reflex tachycardia, and occasionally nausea.
• Tolerance develops with prolonged nitrate use 
patients should have an 8- to 12-hour nitrate-free
period every 24 hours.
 For Acute Attack

• Choose Sublingual nitrate

• The dosage is 0.3 or 0.4 mg Provides
symptomatic relief within 3 minutes.
• If there is no relief after 5 minutes 
repeated up to a maximum of three tablets.
 For Prophylaxis
• Choose sustained-release formulations (long
acting).
• Sustained-release nitrates are good for
patients whose angina is characterized by
vasospasm.
• Since tolerance develops with prolonged
nitrate use, patients should have an 8- to 12-
hour nitrate-free period every 24 hours
Dose
 2. Beta Blocker
• As first line in SA unless there are
contraindication.
• It reduce oxygen demand by decreasing heart
rate, blood pressure, myocardial contractility,
and left ventricular afterload.
• Beta1-selective BBs should be used
(metoprolol, atenolol, bisoprolol)
• Also used in USA and NSTEMI MI
 Dose BB for Angina
atenolol 50-200 mg/day
bisoprolol 10 mg/day
metoprolol 50-200 mg/day
 3. Calcium Channel Blocker
• Make vasodilation of arterioles and the coronary
arteries
• Decrease oxygen demand by reducing blood
pressure, contractility, and afterload.
• Use diltiazem and verapamil, nifedipine.
• Used as first-line therapy in variant angina, when
BBs are contraindicated or as combination with
BB. .
• Caution in patients with heart failure.
Dose
 Acute Coronary Syndrome

 STEMI myocardial infarction

 NON STEMI myocardial infarction
 Unstable angina
 General Treatment
• Morphin, 1-5 mg IV can be repeated in 10-30
M minute. Its given when severe pain or no
response with nitrate

O • Oxygen, 4-8 L/minute

N • Nitrates: nitrogliserin Subling repeated in 5

minute, max 3 time  IV if no response

• Aspirin, dose160-320 mg
A • Adenosin diphospate receptor blocker (ticaglelor,
clopidrogrel
 Resep
• Tuliskan resep sebagai berikut:
• Nitrogliserin sublingual
• Nifedipine sublingual
• Beta blocker dan CCB untuk profilaksis angina
stable
• R/ (5) nitrogliserin (5) sublingual tab (5) 0,4 mg (5)
no. X
S 1 dd tab I sublingual jika nyeri dada (5)
• R/ nifedipine sublingual tab 10 mg no. X
S 1 dd tab 1 sublingual jika nyeri dada
• R/ bisoprolol tab 10 mg no XX
S 1 dd tab I
• R/ verapamil tab 60 mg no. LX
S 3 dd tab I
 Post Test
1. Seorang pasien datang ke UGD dengan keluhan data yang
sudah berlangusng selama 5menit. Obat yang diberikan
adalah...
2. Seorang pasien didiagnosis stable angina. Keluhannya timbul
cukup sering, terutama saat dia beraktivitas. Obat pencegahan
angina yang tepat untuk pasien tersebut adalah...
3. Seorang pasien didiagnosis stable angina. Keluhannya timbul
cukup sering, terutama saat dia beristirahat dan cuaca dingin.
Obat pencegahan angina yang tepat untuk pasien tersebut
adalah...
4. Mekanisme kerja nitrogliserin adalah ....
5. Beta blocker yang digunakan untuk pencegahan
serangan angina adalah....
6. Calcium channnel blocker yang mempunyai efek
kronotropik negatif minimal adalah...
7. Calcium channnel blocker yang tidak mempunyai
efek kronotropik negatif adalah ....
8. Mekanisme kerja verapamil adalah...
9. Mekanisme kerja morphin dalam terapi serangan
angina sebagai ....
10. Mekanisme kerja aspirin dalam terapi acute
coronary syndrome sebagai.....