blok DMS
A + B ?
Precipitant Drug Object Drug
yg mempengaruhi yg dipengaruhi
INTERAKSI OBAT
INTERAKSI FARMASEUTIK
INTERAKSI FISIOLOGIS
Interaksi Obat
• reseptor yang sama pada organ yang
sama
• reseptor berbeda pada organ yang sama
• reseptor berbeda pada organ berbeda
Interaksi Farmakodinamik
NSAID ± SEVERE
adjuvant analgesic
± weak opioid
(codein)
MODERATE
paracetamol
or NSAID ± chronic pain
adjuvant analgesic
pain persists or increases
MILD
PAIN
Opioids
Alpha-2 agonists
Local anesthetics
Opioids
Alpha-2 agonists
Local anesthetics
TRAUMA
Local anesthetics
Anti-inflammatory
drugs
PRE-SYNAP OPIOIDS POST-SYNAP
µ1
NMDA
INHIBITION
Glu
ACTIVATION
Subs.P
M1 NK-1
2 PAIN
Adr 2
CLONIDINE
ACh INHIBITION
GABA GABA
MIDAZOLAME
Supra Adisi (Synergy)
Ketoprofen2
Diclofenac2 Paracetamol
Morphine1
Metamizol Piroxicam2
Carbachol2
Meloxicam2
1.Miranda H.F., Silva.E., Pinardi G;Synergy between the antinociptive effects of morphine
and NSAIDs; Canadian Journal of Physiology & Pharmacology, 2004.
2. Miranda H.F., Siereralta, Pinardi G; Carbachol interactions with NSAIDs,
Canadian Journal of Physiology & Pharmacology, 2002.
Interaksi DMS
Obat A Obat B Efek
NSAID NSAID
NSAID ANALGETIKA
MURNI
(Parasetamol)
NSAID STEROID
NSAID MUSCLE
RELAXANT
NSAID Anti-Diabetes
NSAID Anti-Hipertensi
Interaksi DMS
Obat A Obat B Efek
Topical Antibiotic
Corticosteroid topical
Topical Anti-fungi
Corticosteroid topical
Topical NSAID
Corticosteroid topical
Topical Anti-Diabetes
Corticosteroid
Topical Anti-Hipertensi
Corticosteroid
Interaksi
efek apa yang bakal terjadi?
R/ Lameson tab No X
S 3 dd tab II
R/ Valium 5 mg tab No X
S 3 dd tab I
Tentukan mana yang lebih ideal
peresepan obat racikan atau sedia jadi
Ucok, 2 tahun 2 bulan, 11 kg, datang ke dokter
dengan keluhan menangis, batuk, demam,
malas makan, mual dan merasa nyaman bila
dipijat-pijat. Ucok didiagnosis tonsillopharyngitis
akut dan akan diresepkan:
Amoxycillin 25-50 mg/kg/hari
Parasetamol 100 mg/kali beri
Codein 1 mg/tahun usia/kali beri