PHARMACOLOGY OF

CORONARY ARTERY DISEASE

 Skenario
• Tn. G (61 tahun) dirawat di rumah sakit dengan keluhan sesak
nafas serta nyeri dada kiri yang menjalar ke lengan kiri. Klien
mengatakan sulit untuk melakukan berbagai kegiatan aktivitas
seperti dulu, dan saat ini hanya bisa tiduran. Klien mempunyai
riwayat diabetes mellitus dan perokok aktif sejak usia 15
tahun. Klien menanyakan aktivitas apa saja yang bisa
dilakukan pada kondisi seperti itu dan mengapa kondisi klien
tidak sekuat dulu waktu dia masih muda. Ners Dina merawat
klien selama di rumah sakit dan mengatakan bahwa kondisi
klien saat ini dikarenakan adanya proses penuaan.
 Risk factors
• diabetes
• hyperlipoproteinemia,
especially high LDL and low
HDL
• high blood pressure
• family history of ischemic
heart disease
• obesity BMI>30 kg/m²
• age M>45, F>55
• stress
• alcohol
Atherosclerosis

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END
Clinical Definitions
 Clinical presentation
• chest pain (typically radiating to the left arm
or left side of the neck)
• shortness of breath (dyspnea)
• nausea, vomiting
• palpitations
• sweating
• anxiety
Diagnosis of STEMI is
based on any two of the
following :
1. chest pain.
2. ECG changes or new
LBBB.
3. raised biomarkers.

Lilly LS. Pathophysiology of heart disease. 5th ed. Lipincott Williams & Wilkins; 2011
 Jenis Angina

• Angina
stabil/klasik/exertio
nal/ exercise-induced
• Angina tidak stabil
• Angina
variant/vasospastik/
Prinzmetal
 Terapi Angina
• Tujuan:
 mengurangi gejala
 mencegah terjadi serangan ulang
• Cara:
  suplai oksigen   aliran darah koroner
  kebutuhan oksigen miokard   beban jantung
• Jenis obat:
 Nitrat organik (nitrovasodilator)
 Antagonis kalsium
 Beta-bloker
Nitrat Organik

Mekanisme kerja
• Dilatasi arteri koroner dan vena besar
  suplai oksigen &  preload
• Melepas NO   cGMP intrasel 
relaksasi otot polos
 Anti Angina – Nitrate
Mode of action
• Muscle relaxation
• Venodilation -  preload
• Coronary artery
vasodilation -  supply
• Moderate arteriolar
dilation -  afterload
Nitrat Organik

• Nitrogliserin
• Isosorbid dinitrat
• Eritritil tetranitrat
• Pentaeritritol tetranitrat
Anti Angina – Nitrate
Nitrat Organik

• Larut lemak
• Metabolisme cepat
• Cocok untuk semua jenis angina
• Akut dan profilaksis
• Efek samping: sakit kepala, hipotensi
ortostatik, flushing, takikardi
• Toleransi, ketergantungan fisik
 Anti Angina – Calcium Antagonist
Mechanism of Action
• Prevent opening of voltage-
gated calcium channels
• Bind to -1 subunit of cardiac
and smooth muscle L-type
calcium channels
• Vasodilator effect on resistance
vessels  afterload
• Coronary artery dilation
• Negative chronotropic
• Negative inotropic effects
 Anti Angina – Calcium Antagonist
Indications Side Effects
• Symptomatic control of angina Tergantung jenis antagonis
• Coronary spasm kalsium:
• Hypertension • Nifedipin: hipotensi, sakit
• Arrhythmias kepala
• Subarachnoid haemorrhage • Verapamil: hipotensi,
(nimodipine) kardiodepresi
• Diltiazem: kardiodepresi

Depresi Depresi
Vasodilatasi  kontrak-
Nodus Nodus
koroner tilitas
SA AV

Nifedipin +++++ + + -
Verapamil ++++ ++++ +++++ +++++

Diltiazem +++ ++ +++++ ++++

 Anti Angina – Beta Blocker
• Therapeutic effect  decrease
the rate and force of the cardiac
contraction (resulting in
decreased 02 demand) and
decrease vasoconstriction in the
myocardium and vasculature.
• Mechanism of Action  inhibit
circulating catecholamines from
stimulating beta receptor sites.
• There are two type of beta
receptors (B1 & B2).
 Beta-bloker

 Propanolol  Penbutolol
 Nadolol  Osprenolol
 Timolol  Alprenolol
 Pindolol  Metoprolol
 Asebutolol  Esmolol
 Atenolol  Labetalol
 Karteolol
 Principles of treatment

• Increase oxygen supply or reduce oxygen

demands of myocardium
• Reduce heart rate
• Reduce preload
• Reduce afterload
• Improve coronary blood flow
 Antithrombus therapy
• Anticoagulant
• Antithrombotic
• Fibrinolytic
 Antithrombus therapy
Anticoagulant Indication
Indirect Trombin Inhibitor • CAD (Coronary Artery
• Heparin Disease), DVT (Deep vein
• Warfarin thrombosis), pulmonary
• Rivaroxaban embolism, RHD (Rheumatic
Direct Trombin Inhibitor heart disease)
• Bivalirudin, Hirudin, Lepirudin,
Argatroban
• Dabigatran, Ximelagatran
LMWH
• Bemiparin, dalteparin,
enoxaparin, reviparin,
fondaparinux
 Antithrombus therapy
Anti trombotik Indication:
• Aspirin • Miocard infarct
• Clopidogrel • Thrombus in TIA/stroke
• Ticlopidin
• Dipyridamol
• Cilostazol
 Trombolitic
Fibrinolytic
• Streptokinase
• Urokinase
• Plasminogen activator (u-PA, t-
PA)
Indication:
• Miocard infarct, pulmonary
embolism, vessel thrombosis