Tugas Geriatri STW Cibubur

1. Grading ulkus dekubitus (I-IV)

Sumber: Schwartzs
Principles of Surgery,
10th editions.

2. Apa isi obat nebulisasi (pulmicort, ventolin, combivent), sediaan berapa aja, dan
bagaimana cara kerjanya?
Isi Sediaan Cara Kerja
Selective 2-adrenoreceptor agonist
(it acts on bronchial muscle
Ventolin providing short acting (4-6 hr)
nebules 2.5 bronchodilation with a fast onset
Ventolin Salbutamol
mg/2.5 mL (within 5 min) in reversible airways
obstruction, with little or no action
on the 1-adrenoreceptors of cardiac
muscle
Pulmicort Corticosteroid for inhalation use in
respules the treatment and prophylaxis of
0.25 mg/mL asthma, counteract the mainly
Pulmicort Budesonide
Pulmicort "IgE, suppress plasma cortisol
respules 0.5 levels and produced bronchodilation
mg/mL
Anticholinergic (parasympatholytic)
properties, prevent the increase in
Kombinasi Combivent
intracellular concentration of
Salbutamol + unit dose vial
Combivent Ca++ which is caused by interaction
Ipratroprium 2.5 mL x 20
of acetylcholine with the muscarinic
Bromide
receptor on bronchial smooth
muscle
Sumber: MIMS Pharmacology

Kristian Felix (406152061)

Geriatri STW Cibubur
Periode 21 Agustus 23 September 2017
3. Hubungan pertambahan usia dengan isolated systolic hypertension?

ISH should be diagnosed with SBP as 140 mm Hg and diastolic BP (DBP) as 90 mm Hg.
Changes in the mechanical properties of large vessels, such as a decrease in arterial
compliance, are responsible for the increase in systolic with concomitant decrease in diastolic
BP. Aging is per se associated with the deterioration in arterial compliance through both
structural and functional changes in large arteries which mainly involves the intima and
media. The observed changes result in a decrease of the lumen-to-wall ratio, the overall
lumen cross-sectional area and an increase of arterial stiffness which especially involve the
aorta and other elastic arteries.

Sumber: Kocemba J, et al. Isolated Systolic Hypertension: pathophysiology, consequences,

and therapeutic benefits. Journal of Human Hypertension 1998;12: 6216.

4. Apa dampak peningkatan pCO2 dan pO2 dalam sistem tubuh secara keseluruhan?

Sumber: Morgans and Mikhails

Clinical Anesthesiology, 5th
edition

5. Apa itu hipertensi urgensi, hipertensi emergency dan hipertensi maligna?

Kristian Felix (406152061)

Geriatri STW Cibubur
Periode 21 Agustus 23 September 2017
6. Cara kerja dan golongan obat anti-hipertensi

Sumber: www.ebmedicine.net/

7. Hubungan edema cerebri dan hiponatremia?

When hyponatremia occurs, the resulting decrease in plasma osmolality causes water
movement into the brain in response to the osmotic gradient, thus causing cerebral edema.

Sumber: Giuliani C, Peri A. Effects of hyponatremia on the brain. J Clin Med 2014; 4:
1163-77.

Kristian Felix (406152061)

Geriatri STW Cibubur
Periode 21 Agustus 23 September 2017
8. Cara kerja dan golongan obat diabetes mellitus

Sumber: Konsensus Pengelolaan dan

Pencegahan Diabetes Melitus Tipe 2
- 2015

9. Dampak hiperglikemia berkepanjangan atau komplikasi kronik

Sumber: Paneni F,
et al. Diabetic and
vascular disease.
Eur Heart J 2013;
34: 2436-46.

Kristian Felix (406152061)

Geriatri STW Cibubur
Periode 21 Agustus 23 September 2017
10. Patomekanisme Alzheimer Disease dan faktor risiko

Apolipoprotein E (ApoE) is a major cholesterol carrier that supports lipid transport and injury
repair in the brain. APOE polymorphic alleles are the main genetic determinants of
Alzheimer disease (AD) risk: individuals carrying the 4 allele are at increased risk of AD
compared with those carrying the more common 3 allele, whereas the 2 allele decreases
risk. APOE 4 is a major genetic risk factor for Alzheimer disease. Presence of
the APOE 4 allele is also associated with increased risk for cerebral amyloid angiopathy and
age-related cognitive decline during normal ageing. ApoElipoproteins bind to several cell-
surface receptors to deliver lipids and also to hydrophobic amyloid- (A) peptide, which is
thought to initiate toxic events that lead to synaptic dysfunction and neurodegeneration in
AD.

Risk factor: DM, traumatic

brain injury, vascular disease

Sumber: Liu CC, et al.

Apolipoprotein E and
Alzheimer disease: risk,
mechanisms, and therapy. Nat
Rev Neurol 2013; 2: 106-18.

11. Obat Alzheimer, sediaan dan nama dagang

Sumber: Goodman & Gillmans The Pharmacological Bases of Therapeutics, 12th Edition.

Kristian Felix (406152061)

Geriatri STW Cibubur
Periode 21 Agustus 23 September 2017
12. Angka harapan hidup lanjut usia di Indonesia
Sejak tahun 2004 - 2015 memperlihatkan adanya peningkatan Usia Harapan Hidup di
Indonesia dari 68,6 tahun menjadi 70,8 tahun dan proyeksi tahun 2030-203 mencapai 72,2
tahun. Bila dilihat lansia berdasarkan jenis kelamin, penduduk lansia yang paling banyak
adalah perempuan.

Kristian Felix (406152061)

Geriatri STW Cibubur
Periode 21 Agustus 23 September 2017
13. Empat jalur dopamine (four dopamine pathaway)

Empat jalur dopamine (four dopamine pathaway)

The four pathways relevant to the pharmacology of antipsychotics in the treatment of
schizophrenia are:
The mesolimbic pathway (positive symptoms)
The mesocortical pathway (negative symptoms)
The nigrostriatal pathway (extrapyramidal symptoms and tardive dyskinesia)
The tuberoinfundibular pathway (hyperprolactinemia)

Sumber: Golan D, Tashjian AH, Armstrong EJ. Principles of Pharmacology: The

Pathophysiologic Basis of Drug Therapy 4th Edition. Philadelphia: Lippincott Williams &
Wilkins, 2011.

14. Parkinsons disease Criteria

Parkinsonism is a clinical syndrome consisting of four cardinal features:

bradykinesia (slowness and poverty of movement)

muscular rigidity
resting tremor (which usually abates during volun- tary movement)
an impairment of postural balance leading to disturbances of gait and falling

15. Parkinsons disease Grading

Modified Hoehn and Yahr Staging

Stage 1 Unilateral disease
Stage 2 Bilateral disease, without impairment of balance
Stage 3 Mild to moderate bilateral disease; some postural instability;
physically independent
Stage 4 Severe disability; still able to walk or stand unassisted
Stage 5 Wheelchair bound or bedridden unless aided

16. Wearing Off phenomenon

Wearing-off is a term that refers to a fluctuation in the symptoms of a person suffering from
Parkinsons disease. Wearing-off is where you begin to feel that the improvement gained
from a dose of levodopa does not last until the next dose of medication begins to take effect.
The on-off phenomenon refers to sudden, sometimes unpredictable, changes in your
symptoms, varying between good and poor mobility. The ON-phase is when a Parkinsons
disease (PD) patient finds that their levodopa medication is having benefit, and their
Parkinsons symptoms are generally well controlled; the OFF-phase is associated with
Parkinsons symptoms.

Kristian Felix (406152061)

Geriatri STW Cibubur
Periode 21 Agustus 23 September 2017
17. Obat Parkinson, sediaan dan nama dagang

Sumber: Goodman & Gillmans The Pharmacological Bases of Therapeutics, 12th Edition.

18. Klasifikasi nyeri (nociceptive, neuropathic, psychogenic)

Nociceptive: pain due to continuous tissue injury; actual or threatened damage to non-
neural tissue results in activation of peripheral nociceptors (somatic and visceral pain)
Neuropathic: pain arising as a direct consequence of a lesion or disease affecting the
somatosensory system (peripheral and central pain)
Psychogenic: physical pain that is caused, increased, or prolonged by mental,
emotional, or behavioral factors. Headache, back pain, or stomach pain are some of
the most common types of psychogenic pain
Sumber: Morgans and Mikhails Clinical Anesthesiology, 5th edition

Kristian Felix (406152061)

Geriatri STW Cibubur
Periode 21 Agustus 23 September 2017
19. Perbedaan antara GTN and ISDN

Sumber: Fung HL. Do nitrates differ? Br. J Clin Pharmac 1992; 34: 5-9.

20. Mekanisme ereksi (tiga jalur)

Kristian Felix (406152061)

Geriatri STW Cibubur
Periode 21 Agustus 23 September 2017
 Sumber:
Dean
RC, Lue
TF.

Physiology of penile erection and pathophysiology of erectile dysfunction. Urol Clin North
Am. 2005; 32: 379-95

Kristian Felix (406152061)

Geriatri STW Cibubur
Periode 21 Agustus 23 September 2017
21. Pemeriksaan klinis pada andropause dan menopause

Criteria for Andropause/Menopause Disorder

In the same two weeks, the patient has had four or more of the following. Either depressed
mood or decreased interest must be one of the four. These symptoms cause distress and/or
impaired functioning. Abnormally low hormone levels are also required.
Depressed mood, or loss of eagerness and enthusiasm for daily life
Decreased desire or interest for activity (including sexual activity)
Irritability
Weight gain
Decreased energy, fatigue
Insomnia
Difficulty concentrating, decreased mental quickness and sharpness
Abnormally low hormone levels (Required)
The following Physiological Symptoms may also exist.
Decreased muscle tone
Night sweats and/or hot flashes
Migraine headaches (more often seen in women)
Heart palpitations (more often seen in women)

Exclusively seen in women:

Involuntary urine release and bladder urgency
Irregular and/or heavy periods
Vaginal dryness and painful intercourse

Exclusively seen in men:

Decreased sexual function (impotence) or decreased sensitivity
Men and women both may experience decreased sexual drive
The patient may also develop anxiety and/or panic attacks.

Sumber: Andropause/Menopause Disorder, Eberly 2009

Kristian Felix (406152061)

Geriatri STW Cibubur
Periode 21 Agustus 23 September 2017