21.Reteta: Cardiopatie ischemica, angina pectorala de efort

Question 1

Rp 1/ 2 / 3 / 4

Answer 1

Rp1/ Nitroglicerina cpr 0,5 mg
AO nr I(unu)
DS sublingual 1cpr la nevoie
#
Rp2/Isosorbid dinitrat cpr 20 mg
AO nr I (unu)
DS oral 2x1 cpr/zi, 30 zile
#
Rp3/Betaxolol cpr 20 mg
AO nr I (unu)
DS oral 1 cpr/zi , 30 zile
#
Rp4/ Clopidogrel cpr 75mg
AO nr I (unu)
DS oral, 1x2 cpr/zi, dupa masa, 30 zile

Question 2

1.Clasificare

Answer 2

Nitroglicerina – antianginos, derivat nitrat cu durata scurta de actiune
Isosorbid dinitrat - antianginos, derivat nitrat cu durata lunga de actiune
Betaxolol - antihipertensiv, Beta blocant selectiv
Clopidogrel – antitrombotic, antiagregant plachetar, inhibitori ai agregarii plachetare

Question 3

2. Forma farmaceutica + doza +mod de adm

Answer 3

 Nitroglicerina cpr 0,5 mg sau spray 0,4mg/puf (sublingual), plasture 10mg/24h, 5mg/24h (transdermic), cpr 2,6mg (oral), ung. 2% precordial (cutanat)
 Isosorbid dinitrat cpr 10 mg; 20mg; cpr 40mg
 Betaxolol cpr 20 mg
 Clopidogrel cpr filmate 75mg, 1cpr/zi administrat la aceeasi ora

Question 4

3.Actiune FD

Answer 4

Clopidogrel:
-prodrog (devine activ doar dupa metabolizare hepatica)
-absorbtie per os rapida
-Inhibă activarea și agregarea trombocitară

Nitroglicerina: Derivati nitrati -> scade [Ca2+ ]ic -> Relaxare musc neteda vasculara
- VD venoasa -> scade intoarcerea venoasa, Presarcina, travaliu cardiac si consumul O2
-VD A coronare: creste DC cu fav redistribuirii sange spre zone ischemiate
-au si efect antiagregant plachetar

Betaxolol:
-efect inotrop, cronotrop, dromotrop, batmotrop NEGATIV
-antiaritmica, antianginoasa si coronarodilatatoare
-antihipertensiva prin blocarea Rec β1-cardiaci
-antiglaucomatoasa

Question 5

4.Indicatii terapeutice

Answer 5

Nitroglicerina:
 angina pectorala de efort stabila sau instabila
 Insuficienta cardiac congestive (+ digitalice, +diuretice), IMA
 Criza de angina pectorala, EPA

Clopidogrel (se adm oral, in 1-2prize/zi)
 Profilaxia secundara boli CV / prevenire accidente aterotrombotice
 Sindrom coronarian acut
 Preventia trombozei de stent
 Substituent al Acidului acetilsalicilic la cei alergici

Betaxolol:
 HTA
 aritmii
 glaucom, prin scaderea presiunii intraoculare prin scaderea secretiei apoase
 cardiopatie ischemica, angina pectorala, angina cronica stabila
 insuficienta cardiaca
 betablocantele neselective pot determina bronhoconstrictie, fiind contraindicate la bolnavii cu astm bronsic, BPOC.

Question 6

5.Efecte adverse

Answer 6

Nitroglicerina: cefalee pulsatila, hipotens arteriala ortostatica, tahicardie reflexă

Clopidogrel: iritatie gastrica, microhemoragii digestive, tulburari GI, Leucopenie

Betaxolol:
 bronhospasm cu agravarea astmului bronsic
 deprimare cord cu scadere contractilitate miocard
 bradicardie
 ischemie periferica
 hipoglicemie la diabetici
 fenomene de rebound la intreruperea brusca a tratamentului
 disfunctie sexuala – impotenta la barbate, infertilitate la femei
 insomnie, vise bizare, fatigabilitate

Question 7

6. Contraindicatii

Answer 7

Nitroglicerina: soc, hipotensiune, stenoza aortica, presiune intracraniana crescuta

Betaxolol: Absolute: BAV, bradicardie severa, astm bronsic sever, depresii psihice severe
Relative: BPOC, Sd. Raynaud, HTA in sarcina

Clopidogrel: gastrită, ulcer gastroduodenal, astm, alergie la salicilaţi