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PERMASALAHAN OBAT

1 M.SABIR

FARMAKOLOGI,PSIK, OKTOBER 2011

REAKSI ALERGI
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OVERDOSIS USIA MEREK DAGANG PENYAKIT GANGGUAN EMOSI DAN MENTAL

FARMAKOLOGI,PSIK, OKTOBER 2011

4 KATEGORI
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TIPE 1 ANAFILAKTIK

TIPE 2 SITOTOKSIK
TIPE 3 KOMPLEKS IMUN TIPE 4 HIPERSENSITIFITAS TERLAMBAT

FARMAKOLOGI,PSIK, OKTOBER 2011

TIPE 1
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SHOCK ANAFILAKTIK

URTIKARIA AKUT
EDEMA LARINGS ASMA AKUT
PENISILIN DEKSTRAN KONTRAS BERYODIUM TIOPENTON RELAKSAN OTOT

HIPOTENSI

FARMAKOLOGI,PSIK, OKTOBER 2011

TIPE 2
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ERITROPESIS DARAH

HEMOLITIK NEONATUS
TRANSFUSI DARAH ANEMIA HEMOLITIK
PENISILIN SEFALOTIN QUINIDIN RIFAMPICIN METILDOPA

AGRANULOSITOSIS OBAT

FARMAKOLOGI,PSIK, OKTOBER 2011

TIPE 3
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DEMAM

URTIKARIA
ARTRALGIA TROMBI
PENISILIN SULFONAMID STREPTOMISIN HIDRALAZIN TIOURASIL ISONIASID RIFAMPICIN

HEMORAGI
NEFRITIS ARTRITIS REUMATOID

FARMAKOLOGI,PSIK, OKTOBER 2011

TIPE 4
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DERMATITIS KONTAK

REAKSI PENOLAKAN

TRANSPLANTASI REAKSI AUTOIMUN

PERHIASAN CANGKOK ORGAN TUMOR TIROID

FARMAKOLOGI,PSIK, OKTOBER 2011

INTERAKSI OBAT
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SINERGISME

ANTAGONISME

FARMAKOLOGI,PSIK, OKTOBER 2011

INKOMPATIBITAS FARMAKOLOGIS
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ANTIKOAGULAN HEPARIN (ASAM) DIHAMBAT

DENGAN PEMBERIAN PROTAMIN (BASA) PROTAMIN MERUPAKAN ANTIDOTE OVERDOSIS HEPARIN

FARMAKOLOGI,PSIK, OKTOBER 2011

GANGGUAN ABSORPSI SALURAN CERNA


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METOCLOPRAMIDE MEMPERCEPAT

PENGOSONGAN LAMBUNG TETRASIKLIN DIIKAT OLEH ION CALSIUM,ION MAGNESIUM DAN ALUMINIUM (KOMPONEN ANTASIDA) DAN ION Fe

FARMAKOLOGI,PSIK, OKTOBER 2011

PERGESERAN IKATAN PROTEINPLASMA


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AFINITAS OBAT DAPAT MENGGESER OBAT

YANG LAIN KONSENTRASI OBAT TERGESER MENINGKAT DIDALAM DARAH ANTIKOAGULAN (WARFARIN) MENINGKAT DENGAN PEMBERIAN FENILBUTAZON EFEK METOTREKSAT MENINGKAT DENGAN ASPIRIN DAN SULFA

FARMAKOLOGI,PSIK, OKTOBER 2011

KETERGANTUNGAN OBAT
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NARKOTIK (OPIAT)

BARBITURAT/ALKOHOL
CANNABIS KOKAIN

AMFETAMIN
HALUSINOGEN ALKOHOL

PELARUT YANG MUDAH MENGUAP

FARMAKOLOGI,PSIK, OKTOBER 2011

TERAPI KETERGANTUNGAN
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WITHDRAWL

PRINSIP 1.GANTI OBAT FISIOLOGI & FARMAKOLOGI EKUIVALEN 2. MENGURANGI OBAT EKUIVALEN

FARMAKOLOGI,PSIK, OKTOBER 2011

KESALAHAN PEMBERIAN OBAT


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LUPA PEMBERIAN OBAT

MEMBERI DUA KALI OBAT YANG DILUPAKAN

SEBAGAI KOMPENSASI MEMBERI OBAT BENAR WAKTU YANG SALAH MEMBERI OBAT BENAR RUTE YANG SALAH

FARMAKOLOGI,PSIK, OKTOBER 2011

KEPATUHAN
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KETIDAKPATUHAN TERHADAP PENGOBATAN; KURANG PAHAM TUJUAN PENGOBATAN SUKAR MEMPEROLEH OBAT DILUAR RS MAHALNYA HARGA OBAT KURANG PERHATIAN DAN KEPEDULIAN KURANG MENGIKUTI ATURAN PENGOBATAN

FARMAKOLOGI,PSIK, OKTOBER 2011

Type I Reaction
Polyvalent protein-

drug complexes crosslink IgE bound to mast cells and basophils leading to release of preformed mediators and synthesis of leukotrienes

Type II Reaction
Drug-specific

antibodies react with a cell-bound form of the drug results in cytotoxicity; or function as autoantibodies, cross-react with native proteins results in complement mediated lysis

Type III Reaction


Circulating immune

complexes consisting of the drug and specific antibodies attach to vascular walls resulted in inflammation.

Type IV Reaction
Drug bound to TcR

induces cytokine releases and then inflammatory reactions

Classification of drug eruption based on immunological mechanisms

Type Mechanisms I

Details

Manifestations
Anaphylaxis, Angioedema, Brochospasm, urticaria Lysis, Cytopenia, Drug purpura Bullous drug eruptions ?

Ig E dependent Antigen cross-links Ig E bound to Mast cells (immediate-type and basophils, release of prefrormed hypersensitivity) mediators (eg. Histamin) and newly mediators (eg. Leukotrienes) Complement mediated cytotoxicity Complement activations are via antigenIgG/IgM? reactions. The antigens are : Drug-modified cell surface antigen Drug that covalently linked to the host cell membrane Systemic drug. Drug and antibody form immune complexes which affix to cell membrane Deposition immune complex in the tissue and elicit immune injury

II

III

Immunecomplex depositions Delayed-type hypersensitivity

Vasculitis, urticaria, exanthema, maculopapular. contact dermatitis, Maculopapular, Exanthema ?

IV

T lymphocytes are sensitized by antigen, resulting in cytokine release, mononuclear cells recruitment, vesicle formations, edema

CLINICAL MANIFESTATIONS

Systemic
Anaphylaxis Serum

Hematologic
Lung Liver Kidney Neurologic

sickness Drug fever Vasculitis

Dermatologic
Mild

Makulopapular (morbiliformis) Urtikaria Contact Allergi Photoallergy Fixed drug eruption Eritema multiforme Stevens Johnson syndrome TEN

Severe

Diagnosis
Medical history (Risk factors, characteristic)

Clinical Examination (morphology)


Other investigations: Skin test Allergen specific IgE
INVESTIGATION

EXAMINATION

HISTORY

Sistem MUSKULOSKELETAL

KELUHAN YANG PALING SERING :


NYERI / LINU / PEGEL dll

PUSING

Nyeri dan Analgesia

Nyeri an unpleasant sensory and emotional experience with actual or potential tissue damage or described in terms of such damage (International Association for the Study of Pain, 1979) Analgesia Kemampuan tubuh merespon impuls nyeri tanpa kehilangan kesadaran yang ditandai dengan berkurangnya rasa nyeri

Nyeri inflamasi

Pelepasan substansi kimia dan enzim (mediator) yang mempengaruhi aktivitas dan sensitifitas neuron

Prostaglandins, leukotrienes : Sensititasi reseptor Bradykinin and Pg : Stimulasi neuron secara langsung Histamine : Nyeri dan itching

Akibatnya

Kenaikan aktivitas nociceptor Hiperalgesia Edema neurogenik

Jalur nyeri

Tipe neuron penghantar nyeri


- A : first pain, sharp (somatic pain) - C : second pain, dull (visceral pain)

Jalur nyeri normal


thalamus cortex

Kerusakan jaringan histamine bradykinin etc.


Ganglion dorsalis

Lintas spino-thalamic lateral

Serabut A or C

Jenis analgesia

Narcotik

morphine, codeine, Mekanisme kerja di analgesik di CNS, namun mempunyai efek sedatif

Non narcotik

aspirin, ibuprofen, dll berkerja sebagai antiinfalamsi diperifer namun beberapa preparat mempunyai efek sentral

WHO Analgesic Ladder


Severe
Step 3 Strong opioids (e.g., morphine) with or without non-opioids Step 2 Weak opioids (e.g., codeine) with or without non-opioids Step 1 Non-opioids (e.g., NSAIDs, paracetamol)

Moderate

Mild

TERIMA KASIH
47

FARMAKOLOGI,PSIK, OKTOBER 2011