DRUGS

UPH, September 20, 2011 Dr. Hartati Kurniadi SpKJ (K), MHA

1. TERMINOLOGI 2. Penjelasan masing masing zat : a .Opiat b. Kokain c. Ganja d. Ecstasy dan shabu e. Alkohol f. Psikotropika : benzodiazepine g. Rokok 3. Cara-cara Penyuluhan

TERMINOLOGI
NAPZA= narkotika,alkohol,psikotropika, dan zat adiktif lain NARKOTIKA : UU RI Nomor 35/2009: opiat,ganja,kokain,ecstasy, shabu. PSIKOTROPIKA: UU RI Nomor 5/1997 : obat tidur/penenang ALKOHOL : bir, wiski,vodka,tuak saguer brem, dll

TERMINOLOGI
ZAT ADIKTIF LAIN : glue,tembakau,kopi, aseton, dll NARKOBA: narkotika,psikotropika dan bahan adiktif lain DADAH : istilah di Malaysia untuk semua jenis zat yang disalahgunakan MADAT : padanan DADAH, tak tepat karena MADAT adalah candu. Yaitu salah satu jenis opiat

TERMINOLOGI
Zat Psikoaktif => perubahanperilaku, perasaan, kognisi,persepsi,kesadaran. Zat Adiktif => zat yang timbulkan adiksi Adiktif = ketergantungan fisik + ada toleransi, gejala putus zat, keinginan kuat untuk pakai.

TERMINOLOGI
Habituasi = ketergantungan psikis. Intoksikasi = teler = fly = stone = mabok = pakau = parno = perubahan perilaku akibat pengaruh langsung zat psikoaktif

TERMINOLOGI
Gejala putus zat = sakau = gejala yang timbul bila orang yang ketergantungan zat mengurangi atau menghentikan penggunaan zat tsb

ETIOLOGI
B C

ETIOLOGI
A Organo Biologik :

Predisposisi Pencetus Fasilitatif

Faktor genetik (alk, nik,kokain) Peran otak : dopamin, limbik sist. Sifat farmakologik zat : euforia

ETIOLOGI
B Psiko Edukatif : Faktor Kepribadian: Depresi
Ansietas Anti sosial Panik

Identitas jenis yang kabur Latar belakang keluarga : < komunikatif

Over controlling Over Demanding parent

ETIOLOGI
C Sosio Kultural : Lingkungan Sosial :

Kota besar ? Kota kecil ? Daerah kumuh ? Finansial ? Afektif ? Z. Adiktif ttt. Dapat diterima

Lingkungan budaya :
Pengaruh etnik ?

= SIDE EFFECT OF DRUG ABUSE =

OD death invalid traffic accident Substance abuse intox fight Criminal acts DO or loss of job Dep Financial Problems Financial Problem Marital problem Criminal acts abstinence Life- threatening (alc., sedative Amph) Hospitalization Divorce Imprison Other medical complications : Depends on type of drugs tolerance Imprison Needs more rupiahs

Not life threatening (others)

THE QUICKEST WAY TO THE BRAIN

METHOD 1. SMOKING 2. INJECTING : - IV - IM/SC 3. SNORTING 4. CONTACT : - EYE - SKIN & OTHER 5. INGESTING TIME TO BRAIN 7 - 10 SECONDS 15 - 30 SECONDS 3 - 5 MINUTES 3 - 5 MINUTES 3 - 5 MINUTES 15 - 30 MINUTES 20 - 30 MINUTES

DRUGS & THEIR NEURO TRANSMITTERS

Illegal drug Affect Primarily these neuro transmitters - Amphetamine epi, nor epi, acetylcholine,dopamine, serotonin - MDMA epi, nor epi, dopamine, serotonin - Cocaine epi, nor epi, dopamine, serotonin

- Flunitrazepan - Marijuana - Opiates

GABA, glycine anandamide, acetylcholine,dopamine endorphins, enkephalins, dopamine

DATA KASUS

DATA KASUS NARKOBA DI INDONESIA SELAMA 5 TAHUN TERAKHIR (1998 2002)

No. Pekerjaan 1998 1999 2000 2001 2002 Jumlah

1.
2. 3. 4. 5. 6. 7. 8. 9.

PNS
Polri/TNI Swasta Wiraswasta Petani Buruh Mahasiswa Pelajar Pengangguran J U M LAH :

12
6 357 265 90 149 61 35 333 1308

21
10 698 423 95 263 127 105 848 2590

36
37 1268 669 154 569 260 206 1756 4955

39
6 1228 769 127 833 202 141 1579 4924

29
33 1639 619 91 554 241 145 1668 5019

137
92 5190 2745 557 2368 891 632 6184 18769

DATA KASUS NARKOBA DI INDONESIA SELAMA 5 TAHUN TERAKHIR (1998 2002)

(BERDASARKAN PEKERJAAN TERSANGKA)
NO 1. 2. 3. 4. 5. 6. 7. 8. 9. PEK.
PNS POLRI SWASTA WRSWT PETANI BURUH MHSW PELAJAR
PENGANGG URAN

Thn Jml 12 6 357 265 90 149 61 35 333

1308

1998 % 0,92 0,46 27,29 20,26 6,88 11,39 4,66 2,68 25,46 100

Thn Jml 21 10 698 423 95 263 127 105 848

2590

1999 % 0,81 0,39 26,95 16,33 3,67 10,15 4,90 4,05 32,74 100

Thn Jml 36 37 1268 669 154 569 260 206 1756 4955

2000 % 0,72 0,75 25,59 13,50 3,11 11,48 5,25 4,16 35,44 100

Thn Jml 39 6 1228 769 127 833 202 141 1579 4924

2001 % 0,79 0,12 24,94 15,62 2,58 16,92 4,10 2,86 32,07 100

Thn Jml 29 33 1639 619 91 554 241 145 1668 5019

2002 % 0,5 0,66 32,66 12,33 1,81 11,04 4,80 2,89 33,23 100

JML

OPIAT

OPIAT
Asal : tanaman papaver somniferum

Khasiat : analgetik, hipnotik, euforik Opium : getah ( Bahasa Yunani)

OPIAT
Jenis : : opium, morfin, codein : heroin, hidromorfon : meperidin,propoksifen, levalorfan

1. Alamiah 2. Semisintetik 3. Sintetik

OPIAT INTOXICATION
EUPHORIA SEDATION OR SLEEPINES (NODDING) RESPIRATORY DEPRESSION PUPILLARY CONSTRICTION (PINPOINT PUPILS) DYSARTHRIA PERCEPTUAL DISTURBANCES IMPAIRMENT OF MEMORY OR ATTENTION NAUSEA CONSTIPATION WITH DECREASED BOWEL SOUNDS REDUCED SEXUAL DESIRE DELIRIUM MAY OCCUR WITH INTOXICATION

OPIATE WITHDRAWAL
MILD WITHDRAWAL
DYSPHORIC MOOD, ANXIETY, AND RESTLESSNESS LACRIMATION OR RHINORRHEA PUPILLARY DILATATION PILOERECTION SWEATING HYPERTENSION TACHYCARDIA FEVER DIARRHEA INSOMNIA YAWNING

MORE SEVERE
NAUSEA VOMITING MUSCLE ACHES SEIZURES (IN MEPERIDINE WITHDRAWAL) ABDOMINAL CRAMPS HOT AND COLD FLASHES SEVERE ANXIETY

KOMPLIKASI OPIAT (Heroin/Morfin/Putau)

- Pria : impotensi - Wanita : gangguan haid - Gangguan obstipasi - Nafsu makan (kurus) - AIDS, - I.V.User - Hepatitis/radang hati

OPIAT
Kerja di otak : berikatan dengan reseptor opiat : * Di sistem limbik ( pengendali emosi ) : menyebabkan rasa senang, relaks,dan puas. * Di batang otak (pengendali fungsi tubuh: nafas, batuk ): pernafasan melambat, menghentikan batuk. * Di sumsum tulang ( penghantar nyeri ) : menghilangkan nyeri.

OPIAT
Reaksi putus opiat (withdrawal simptom) : Sel otak menjadi hiperaktif

Gejala fisik : reaksi putus obat

Mirip flu berat : nyeri tubuh, demam, berkeringat, menggigil

THE OPIATE FAMILY

Opium poppy

Opium

Morphine

Codein

Thebaine

Heroin

Hydromophone

Dihydrocodeine

Oxycodone

Etorphine

GANJA

GANJA
Asal : tanaman Cannabis Sativa Zat aktif : derta 9 THC - Marijuana : daun dan bunga dikeringkan - Ganja : daun pucuk ( THC = 6 - 7%) - Hashish : getah rebusan daun ( THC = 5 - 12%) - Hash oil : hasil ekstraksi ( pemurnian ) ( THC = 20-50% )

C A N N A B I S INTOXICATION

EUPHORIA DEPERSONALIZATION DEREALIZATION SENSATION OF SLOWED TIME IMPAIRED COORDINATION SILLY OR INAPPROPRIATE AFFECT OR LAUGHING AMOTIVATION CONJUNCTIVAL INJECTION INCREASED APPETITE DRY MOUTH

TACHYCARDIA PERCEPTUAL DISTURBANCES PSYCHOSIS, INCLUDING AUDITORY AND VISUAL HALLUCINATIONS AND PARANOID DELUSIONS (USUALLY THAT PEOPLE ARE WATCHING THEM OR ARE AWARE OF THEIR USE). DELIRIUM MAY OCCUR WITH INTOXICATION.

C A N N A B I S WITHDRAWAL
NOTE : NO DSM CATEGORY

INSOMNIA NAUSEA IRRITABILITY AND RESTLESSNESS YAWNING CHILLS DIARRHEA INFREQUENT OCCURRENCE, ONLY IN CHRONIC USERS OF LARGE AMOUNTS.

SYMPTOMS ARE SELFLIMITED AND MILD, AND NO PHARMACOLOGIC MANAGEMENT HAS BEEN DEMONSTRATED TO BE USEFUL.

KERJA MARIJUANA
Kerja marijuana di otak berikatan dengan reseptor : - Di area hipokampus ( berperan pada memori/ daya ingat ) daya ingat pendek/berkurang - Di sistem limbik ( pengatur emosi ) gangguan emosi : tertawa terbahak atau ketakutan tanpa sebab

KOMPLIKASI GANJA
Bronkhitis/infeksi paru Imunitas berkurang Kemampuan baca terganggu Ketrampilan bicara terganggu Motivasi berkurang Rasa ingin bersaing berkurang Mengganggu janin ( bagi ibu hamil)

KOKAIN

KOKAIN
Asal : Tanaman Eritrosilon Koka Merupakan : Stimulansia SSP

COCAINE INTOXICATION
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. MALADAPTIVE BEHAVIORAL CHANGES ( e.g. EUPHORIA OR HYPERVIGILANCE); TACHYCARDIA OR BRADYCARDIA; PUPILLARY DILATATION; HYPER OR HYPOTENSION; PERSPIRATION OR CHILLS; NAUSEA OR VOMITING; WEIGHT LOSS; PSYCHOMOTOR AGITATION OR RETARDATION; MUSCULAR WEAKNESS, RESPIRATORY DEPRESSION, CHEST PAIN, CARDIAC DYSRHTHMIAS; CONFUSION, SEIZURES, DYSKINESIA, OR COMA

COCAINE WITHDRAWAL
OCCURS SHORTLY AFTER CESSATION FROM PROLONGED USE (12 HRS) AND CAN PERSIST FOR DAYS TO MONTHS. DYSPHORIC OR DYSTHYMIC MOOD. FATIGUE AND SLEEP CHANGES (USUALLY HYPERSOMNIA). PSYCHOMOTOR RETARDATION OR ACTIVATION. VIVID OR UNPLEASANT DREAMS (OFTEN CRACK DREAMS ARE OF USING). PATIENTS MAY DEVELOP SUICIDAL IDEATION AND A PROFOUND SENSE OF GUILT AND HOPELESSNESS.

KERJA KOKAIN
Kerja kokain di otak - Perubahan sifat komunikasi antar neuron - Normal : sistem limbik pengendali rasa senang/ nikmat Neuron neurotransmitter (dopamin) reseptor sel asal kokain (ikat transporter) dopamin menumpuk terus terangsang kenikmatan tambahan (sesaat)

KOKAIN MERUSAK KERJA OTAK

Kokain jangka panjang Dopamin Reseptor dopamin

Sel otak tergantung kokain tak bisa merasa nikmat tampa kokain

KOMPLIKASI KOKAIN
Aritmia jantung/gangguan irama jantung Ulserasi (perlukaan) sampai Perforasi Septum nasi ( sekat rongga hidung) Anoreksia ( hilang nafsu makan ) Anemia, berat badan menurun

AMPHETAMINE

 ECSTACY SHABU

: MDMA : METH AMPHETAMINE

Merupakan : Stimulansia SSP

AMPHETAMINE INTOXICATION
1. MALADAPTIVE BEHAVIORAL CHANGES ( e.g., EUPHORIA OR HYPERVIGILANCE); 2. TACHYCARDIA OR BRADYCARDIA; 3. PUPILLARY DILATATION; 4. HYPER- OR HYPOTENSION; 5. PERSPIRATION OR CHILLS; 6. NAUSEA OR VOMITING; 7. WEIGHT LOSS; 8. PSYCHOMOTOR AGITATION OR RETARDATION; 9. MUSCULAR WEAKNESS, RESPIRATORY DEPRESSION, CHEST PAIN, CARDIAC DYSRITHMIAS; 10. CONFUSION, SEIZURES, DYSKINESIA, OR COMA.

AMPHETAMINE WITHDRAWAL
OCCURS SHORTLY AFTER CESSATION FROM PROLONGED USE (12 HRS) AND CAN PERSIST FOR DAYS TO MONTHS. DYSPHORIC OR DYSTHYMIC MOOD. FATIGUE AND SLEEP CHANGES (USUALLY HYPERSOMNIA). PSYCHOMOTOR RETARDATION OR ACTIVATION. VIVID OR UNPLEASANT DREAMS (OFTEN CRACK DREAMS ARE OF USING). PATIENTS MAY DEVELOP SUICIDAL IDEATION AND A PROFOUND SENSE OF GUILT AND HOPELESSNESS.

KERJA METAMFETAMIN
Stuktur mirip dopamin (neurotransmitter kenikmatan) Masuk neuron pengeluaran dopamin berlebih rasa nikmat Sesudah nikmat hilang crash ( tak nyaman ), tak bisa merasa nikmat menggunakan metamfetamin terus

AKIBAT METAMFETAMIN
Pengaruh pada neurotransmitter lain (serotonin dan norepinefrin) : - lebih aktif dan waspada - tidak bisa tidur, nafsu makan hilang - tekanan darah, denyut jantung , stroke - agresif, mudah marah - curiga berlebihan (paranoid) - halusinasi Kerusakan otak (neuron dopamin dan serotonin) menetap walau obat dihentikan

MDMA, MDA
Jenis amfetamin Merangsang pengeluaran serotonin Pada hewan : merusak neuron (sel saraf) yang mengandung serotonin dapat tumbuh kembali arah tidak sama seperti semula perubahan: - suasana hati (mood) - pola tidur - denyut irama jantung - kemampuan belajar/daya ingat

KOMPLIKASI AMFETAMIN (SHABU,EKSTASI)

Aritmia jantung/gangguan irama jantung Pendarahan intracranial/otak Kematian biasanya karena Hiperpireksia atau syok Kardiovaskuler

SEDATIVES/HYPNOTIC

SEDATIVES/HYPNOTIC
Relatif aman Bahaya ! ! ! Bila dicampur zat lain

SEDATIVES/HYPNOTIC INTOXICATION
DYSARTHRIA ATAXIA IMPAIRED ATTENTION OR MEMORY AMNESIA (BLACKOUTS) NYSTAGMUS STUPOR OR COMA AFFECTIVE LABILITY DELIRIUM OR HALLUCINOSIS MAY BE PRESENT

SEDATIVES/HYPNOTIC WITHDRAWAL
AUTONOMIC INSTABILITY (DIAPHORESIS, ELEVATED HEART RATE, ELEVATED BP, ANXIETY ) TREMOR N/V INSOMNIA PSYCHOMOTOR AGITATION DELIRIUM WITH VISUAL, AUDITORY, OR TACTILE HALLUCINATIONS GENERALIZED TONIC-CLONIC SEIZURES IRRITABILITY

ROKOK

= SMOKING = STOP ?
>3 days
>1 month >3 months >1 year : free of nicotine : lungs clean themselves : - sperms to normal - fertility level : - risk of heart disease - risk of lung cancer

= SMOKING = STOP ?
Appearance: - look better - feel better Stained fingers Yellow teeth < Wrinkles No more stale breath

= SMOKING = STOP ?
BANK ACCOUNT: >>
CONFIDENCE SOARS : IF YOU CAN QUIT SMOKING, YOU CAN HANDLE OTHER CHALLENGES IN LIFE

NICOTINE INTOXICATION

NICOTINE WITHDRAWAL
1. 2. 3. 4. 5. 6. 7. 8. DYSPHORIA OR DEPRESSED MOOD INSOMNIA IRRITABILITY, FRUSTRATION OR ANGER ANXIETY DIFFICULTY CONCENTRATING BREATHLESSNESS DECREASED HEART RATE INCREASED APPETITE OR WEIGHT GAIN

KOMPLIKASI
BRONKHITIS

KANKER PARU

ALKOHOL

ALKOHOL
Gol. A : Ethanol 1% s/d 5% Gol. B : Ethanol > 5% s/d 20% Gol. C : Ethanol > 20% s/d 55% Gol. B & Gol.C Minuman Keras

ALCOHOL INTOXICATION
DYSARTHRIA ATAXIA IMPAIRED ATTENTION OR MEMORY AMNESIA (BLACKOUTS) NYSTAGMUS STUPOR OR COMA AFFECTIVE LABILITY DELIRIUM OR HALLUCINOSIS MAY BE PRESENT

ALCOHOL WITHDRAWAL
AUTONOMIC INSTABILITY (DIAPHORESIS, ELEVATED HEART RATE, ELEVATED BP, ANXIETY) TREAMOR N/V INSOMNIA PSYCHOMOTOR AGITATION DELIRIUM WITH VISUAL, AUDITORY, OR TACTILE HALLUCINATIONS GENERALIZED TONIC-CLONIC SEIZURES IRRITABILITY

ALKOHOL
Menghalangi pesan ke otak mengubah persepsi, emosi, koordinasi Menghambat memori (daya ingat), memperlambat reaksi - kecelakaan lalu lintas Menurunkan kemampuan menilai tingkah laku berisiko : HIV, hamil Menjadi pecandu (alkoholisme) : anak risiko

ALKOHOL
Menyebabkan : - Nafsu makan hilang, kurang vitamin, gangguan lambung, jantung dll. - Sirosis dan kanker hati - Pria : testosteron - impotensi - Wanita : cacat janin (fetal alcohol syndrome)

KOMPLIKASI ALKOHOL
- Gastritis

- Pancreatitis - Cirrhosis hepatis - Polineuritis - Psikosis korsakoff - Kanker saluran cerna

ALKOHOL
Social drinking

At risk drinking regularly exceeding 21 units/week for men, or 14 units/week for women
Problem drinking serious family and social problems occur as a result of drinking Alcohol dependence

20 hari stop alkohol 10 hari stop alkohol

30 hari stop alkohol