INDIVIDUAL ASSIGNTMENT – LAB PHARMACOLOGY

1. Cardiac Cycle Scheme

First ⅓ diastole (Rapid

filling of ventricle)
opening of AV valve

Isovolumetric relaxation
(diakhir systole) ↓ Tekanan Middle ⅓ diastole :
di ventricle, menutupnya sedikit darah yang
semilunar valve, AV valve masuk ke ventrikel
belum terbuka

Period of ejection / Late/last ⅓ diastole mulai

ventricular contraction ada kontraksi atrium,
(opening semilunar semua darah masuk ke
valve) ventrikel

Isovolumetic contraction (
atrial contruction (mirip /
ventrikel mulai kontraksi
sama dengan late ⅓
dengan volume belum
diastole)
berkurang/isovolumetric)

a. Draw form of action potential of ventricular myocardum → Next

b. Through what proces can the cytosolic Ca2+ concentration in the myocardium be
increased or decreased
 Increased cyrosolic Ca2+
- ↑ β adrenergic stimulation → melalui aktivasi Gs protein system →
↑CAMP dari atp → CAMP aktivasi PKAs → memfosforilasi L-type ca
channel → ↑ Ca2+ intra sel
- ↑ ATP → ↑ CAMP
- Na+ ↓ (Melalui Na+ ↔ Ca2+ exchanger)
- K+ intraselluler ↑ (melalui Na + ↔ K+ ATP ase, sehingga Na + yang
keluar ↓, Ca 2+ yang eflux juga ↓ → cytasolic Ca2+ ↑

 Decreased
- ↑ aktivitas Ca2+ induced ATP channel
- ↓ β adrenetgic stimulation
- ↓ ATP
- Na+ ↑ - k + intrasel ↑
 c. Through which transmiter is cardiac activity controlled
- Norepinephrine = ↑ activity
- Epinephrine = ↓ activity

d. Which memrane receptors, ion channels, and second messenger are involved in
regulating cardiac muscle activity
 Membrane receptors
- β, receptor (for nopepinephrine / sympatic) → Gs protein → ↑ CAMP
- muscarinic receptors (for acethylcholine / parasymphatetic) → Gi
protein → ↓ CAMP
 Ion channels (lily hal 13)
- Na+ - K+ atp ase
- Na+ - Ca2+ channel
- Ca2+ channel (Calcium transporter)
- Na+
- Calcium channel
- K+ channels

2. Patophysiology of digitalis intoxination (DI)

 Digotin & other cardiac glycoside cause direct vasoconstriction in the arterial
and venous system in vascular smooth muscle
 + inotropic of digitalis has the following 2 components =
a. Direct inhibition of Na+/K+ ATP ase → ↑ in intracellular Ca2+
b. Associated ↑ in a slow in ward calcium current (ica) during action potential
(AP) this current is the results of movement of calcium into the cell →
contribute to the plateau of AP

Digitalis → inhabit Na+ / K+ ATP ase → ↑ intracelluler Na +, small decrease of

intracelluler K+ occurs, → more influx of Ca2+

Delivered during the plateau of each AP ↑ ica → more calcium

Falls in intracelluler ph
3. Predisposed Factors For Digitalis Intoxication
- penggunaan obat diuretik → Hypkalemia → further inhibits Na + - K+ ATP → ↑
intracellular Ca 2+
- severe hypokalemia
- penyakit ginjal / gagal ginjal → clearance digitalis ↓
- Hypomagnesemia
- Hypercalcemia
- Administration of other drugs (amio.....) → may raise serum digoxin concentration
by altering its clearance or volume of distribution
- Advanied age → metabolism ↓
- Acidosis (Depresses Na+ / K+ atp ase)