KELOMPOK 5 :

1. Novita.E.Permata Sari 110115205

2. Ivan Agung 1101152...
3. Mirza Baladarf 1101152...
4. Monika Puspitasari 110116428
DEFINISI GEJALA
Dispepsia adalah gejala dari
saluran gastrointestinal atas (GI),
hadir selama 4 minggu atau 3
lebih, termasuk nyeri perut bagian
atas atau ketidaknyamanan, nyeri
ulu hati, refluks asam, mual, atau
muntah.

(Dyspepsia and Gastro-oesophageal reflux disease. NICE clinical

guideline 184. 2014)
 FAKTOR PENYEBAB Obat – obatan
Penyakit Sistemik • NSAID
• Hiperkalsemia • Digoxin
• Gagal ginjal • OAD

DYSPEPSIA

Gangguan Gastrointestinal Faktor lain

• Ulkus peptikum • Alkohol
• Batu empedu • Depresi
• Gangguan motilitas • Infeksi H. pylori
KLASIFIKASI DYSPEPSIA
GORD

PEPTIC
DYSPEPSIA ULCER

NSAID & GI
COMPLICATION

UNDIFFERENTIATED DYSPEPSIA
ALARM SYMPTOM
GORD
• Keadaan melemahnya Lower
Esophageal Sphincter (LES) yang
mengakibatkan terjadinya refluks SYMPTOM
• Kembung
cairan asam lambung ke dalam
• Mual
esophagus
• Cepat kenyang
• Bersendawa
• Hipersalivasi
• Heartburn
• Batuk kronis
• Asma
• Suara serak
 PATHOPHYSIOLOGI OF GORD
Intra abdominal
pressure Foods Drugs
(obesity, pregnancy)

Intra abdominal pressure Coffee, alcohol, chocolate, mint, Beta-agonist, calcium channel
(obesity, pregnancy) fatty meals, spicy, citrus blockers, anti-cholinergic

LES misaligned with level of

diaphragmatic contraction
Abnormal LES relaxation

LES seal structural support

Excessive or Prolonged Transient HCl in stomach can be pushed up by intra-

Lower Esophageal Sphincter abdominal pressure or positional changes
Relaxation
ALGORTIME TERAPI
Golongan Terapi
KELAS TERAPI
BAHAN AKTIF DOSIS KONTRA EFEK SAMPING PERHATIAN INTERAKSI OBAT
INDIKASI KHUSUS

Omeprazole Adult: 20 mg once daily Pregnancy Agitation, HEPATIC PPI

for 4 weeks, continued for impotence IMPAIRMENT Not
a further 4–8 weeks if not more than 20mg
fully healed; maintenance daily should be
20 mg once daily needed.

Lansoprazole Adult: 30 mg once daily Hipersensitif Raised Cholesterol HEPATIC PPI

for 4 weeks, continued for terhadap and Triglycerides, IMPAIRMENT Use
further 4 weeks if not lansoprazole anorexia half normal dose in
fully healed; maintenance moderate to severe
15–30 mg once daily, liver disease.
doses to be taken in the
morning
KELAS TERAPI
BAHAN AKTIF DOSIS KONTRA EFEK SAMPING PERHATIAN INTERAKSI OBAT
INDIKASI KHUSUS

Pantoprazole ▶ BYMOUTH Hipersensitif Hyperlipidaemia HEPATIC PPI

Adult: 20–80 mg daily for 4 terhadap IMPAIRMENT Max.
weeks, continued for further 4 pantoprazole 20mg daily in severe
weeks if not fully healed, dose to impairment and
be taken in the morning; cirrhosis. Monitor liver
maintenance 20 mg daily and function in hepatic
increased to 40 mg daily, impairment
increased only if symptoms (discontinue if
return ▶ BY ▶INTRAVENOUS deterioration).
INJECTION, OR BY
INTRAVENOUS INFUSION
Adult: 40 mg daily until oral
administration can be resumed,
injection to be given over at least
2 minutes
KELAS TERAPI
BAHAN DOSIS KONTRA EFEK PERHATIAN KHUSUS INTERAKSI
AKTIF INDIKASI SAMPING OBAT

Famotidine Adult: 20–40 mg twice daily for 6–12 weeks; maintenance Hipersensitif Constipation RENAL IMPAIRMENT Histamine H2-
20 mg twice daily fatigue, vomiting, Use normal dose every 36– antagonists
anorexia, dry 48 hours or use half normal
mouth, flatulence, dose if eGFR less than
nausea, taste 50mL/minute/1.73m2.
disorders Seizures reported very
rarely

Ranitidine ▶ Child 1–5 months: 1 mg/kg 3 times a day (max. per dose 3 Hipersensitif Blurred vision, RENAL IMPAIRMENT Histamine H2-
mg/kg 3 times a day) Alopecia, ▶ In adults Use half normal antagonists
▶ Child 6 months–2 years: 2–4 mg/kg twice daily interstitial dose if eGFR less than
▶ Child 3–11 years: 2–4 mg/kg twice daily (max. per dose nephritis, 50mL/minute/1.73m2. ▶ In
150 mg); increased to up to 5 mg/kg twice daily (max. per involuntary children Use half normal
dose 300 mg), dose increase for severe gastrooesophageal movement dose if estimated
disease disorders, glomerular filtration rate
▶ Child 12–17 years: 150 mg twice daily, alternatively 300 pancreatitis less than
mg once daily, dose to be taken at night, then increased if 50mL/minute/1.73m2
necessary to 300 mg twice daily for up to 12 weeks in
moderate to severe gastro-oesophageal reflux disease,
alternatively increased if necessary to 150 mg 4 times a day
for up to 12 weeks in moderate to severe gastro-oesophageal
reflux disease
PEPTIC ULCER
Luka yang terjadi di dalam lapisan SYMPTOM
perut, bagian atas usus kecil, atau
esofagus • Nyeri abdomen/nyeri ulu hati (sebelah atas
perut)
(TUKAK LAMBUNG) • Mual
• Muntah
• Diare
• Demam
• Lemah
• Hilangnya nafsu makan
• Badan lemah
• Muntah darah
• Berak darah
PATHOPHYSIOLOGI OF PEPTIC ULCER
ALGORTIME TERAPI
Golongan Terapi
KELAS TERAPI
BAHAN AKTIF DOSIS KONTRA EFEK SAMPING PERHATIAN KHUSUS INTERAKSI OBAT
INDIKASI

Omeprazole (Helicobacter pylori Pregnancy Agitation, impotence HEPATIC IMPAIRMENT Not PPI
eradication in combination with more than 20mg daily
amoxicillin and clarithromycin; or in should be needed.
combination with amoxicillin and
metronidazole; or in combination
with clarithromycin and
metronidazole)
Adult: 20 mg twice daily

Lansoprazole (Helicobacter pylori Hipersensitif Raised Cholesterol and HEPATIC IMPAIRMENT Use PPI
eradication in combination with terhadap Triglycerides, anorexia half normal dose in
amoxicillin and clarithromycin; or in lansoprazole moderate to severe liver
combination with amoxicillin and disease.
metronidazole; or in combination
with clarithromycin and
metronidazol)
Adult: 30 mg twice daily
 KELAS TERAPI
BAHAN AKTIF DOSIS KONTRA EFEK SAMPING PERHATIAN INTERAKSI OBAT
INDIKASI KHUSUS
Famotidine Adult: 40 mg once daily for 4–8 weeks, Hipersensitif Constipation RENAL IMPAIRMENT Histamine H2-antagonists
dose to be taken at night fatigue, vomiting, Use normal dose every
anorexia, dry 36–48 hours or use half
mouth, flatulence, normal dose if eGFR
nausea, taste less than
disorders 50mL/minute/1.73m2.
Seizures reported very
rarely
Ranitidine ▶ Child 1–5 months: 1 mg/kg 3 times a Hipersensitif Blurred vision, RENAL IMPAIRMENT Histamine H2-antagonists
day (max. per dose 3 mg/kg 3 times a Alopecia, ▶ In adults Use half
day) ▶ Child 6 months–2 years: 2–4 interstitial normal dose if eGFR
mg/kg twice daily nephritis, less than
▶ Child 3–11 years: 2–4 mg/kg twice involuntary 50mL/minute/1.73m2.
daily (max. per dose 150 mg) movement ▶ In children Use half
▶ Child 12–17 years: 150 mg twice disorders, normal dose if
daily, alternatively 300 mg once daily, pancreatitis estimated glomerular
dose to be taken at night filtration rate less than
▶ Adult: 150 mg twice daily for 4–8 50mL/minute/1.73m2
weeks, alternatively 300 mg once daily
for 4–8 weeks, dose to be taken at
night
UNDIFFERENTIATED DYSPEPSIA
The typical causes of dyspepsia SYMPTOM
are lifestyle factors. Smoking and
a bad diet both contribute to • Signs and symptoms do not
dyspepsia. rise to the level for which
They are the typical and most further investigation is
common reasons for dyspepsia warranted
and as such, they can be
corrected right away. This type
of dyspepsia is called
undifferentiated dyspepsia since
it has no serious causes.
PATHOPHYSIOLOGI OF UNDIFFRTRNTIATED DYSPEPSIA

Merokok

Meningkatkan
produksi asam
lambung

ULCER
ALGORTIME TERAPI
Golongan Terapi
 KELAS TERAPI
BAHAN AKTIF DOSIS KONTRA EFEK PERHATIAN INTERAKSI
INDIKASI SAMPING KHUSUS OBAT
Famotidine Adult: 20–40 mg twice daily Hipersensitif Constipation RENAL IMPAIRMENT Histamine H2-
for 6–12 weeks; maintenance fatigue, vomiting, Use normal dose every 36– antagonists
20 mg twice daily anorexia, dry 48 hours or use half normal
mouth, flatulence, dose if eGFR less than
nausea, taste 50mL/minute/1.73m2.
disorders Seizures reported very
rarely
Ranitidine Adult: 150 mg twice daily for Hipersensitif Blurred vision, RENAL IMPAIRMENT Histamine H2-
6 weeks, alternatively 300 mg Alopecia, ▶ In adults Use half normal antagonists
once daily for 6 weeks, dose to interstitial dose if eGFR less than
be taken at nig nephritis, 50mL/minute/1.73m2. ▶ In
involuntary children Use half normal
movement dose if estimated
disorders, glomerular filtration rate
pancreatitis less than
50mL/minute/1.73m2
 KELAS TERAPI
BAHAN AKTIF DOSIS KONTRA EFEK SAMPING PERHATIAN INTERAKSI OBAT
INDIKASI KHUSUS
Antasida ▶Child 14-17 years : 10 – 20 mL Hypophosphatae Konstipasi Antacids are best Antasida
to be taken 20-60 minutes after mia taken about 1 hour
meals, and at bedtime or when after a meal
required
▶Adult : 10-20mL to be taken
20-60 minutes after meals, and
at bedtime or when required

Omeprazole Adult: 10–20 mg once daily for Pregnancy Agitation, HEPATIC PPI
2–4 weeks according to impotence IMPAIRMENT Not
response more than 20mg
daily should be
needed.
 KELAS TERAPI
BAHAN AKTIF DOSIS KONTRA EFEK SAMPING PERHATIAN KHUSUS INTERAKSI OBAT
INDIKASI
Lansoprazole Adult: 15–30 mg once Hipersensitif Raised Cholesterol HEPATIC PPI
daily for 2-4 weeks, doses terhadap and Triglycerides, IMPAIRMENT Use
to be taken in the morning lansoprazole anorexia half normal dose in
moderate to severe
liver disease.
NSAID & GI COMPLICATION
GI intolerance to NSAID is a SYMPTOM
systemic effect which occurs
whether the drug is taken • Nausea
orally, parenterally or rectally. • Abdominal pain
PATHOPHYSIOLOGI OF DYSPEPSIA CAUSED BY NSAID
ALGORTIME TERAPI
ALGORTIME TERAPI
Golongan Terapi
KELAS TERAPI
BAHAN AKTIF DOSIS KONTRA EFEK SAMPING PERHATIAN INTERAKSI OBAT
INDIKASI KHUSUS

Omeprazole Adult: 20 mg twice daily Pregnancy Agitation, impotence HEPATIC PPI

IMPAIRMENT Not
more than 20mg daily
should be needed.

Lansoprazole Adult: 30 mg twice daily Hipersensitif Raised Cholesterol HEPATIC PPI

terhadap and Triglycerides, IMPAIRMENT Use
lansoprazole anorexia half normal dose in
moderate to severe
liver disease.
KELAS TERAPI
BAHAN AKTIF DOSIS KONTRA EFEK SAMPING PERHATIAN INTERAKSI
INDIKASI KHUSUS OBAT

Pantoprazole Adult: 20–80 mg daily for Hipersensitif Hyperlipidaemia HEPATIC PPI

4 weeks, continued for terhadap IMPAIRMENT Max.
further 4 weeks if not fully pantoprazole 20mg daily in severe
healed, dose to be taken in impairment and
the morning; maintenance cirrhosis. Monitor
20 mg daily and increased liver function in
to 40 mg daily, increased hepatic impairment
only if symptoms return (discontinue if
deterioration).
Misoprostol 200 mcg/day. Increase Hipersensitif Raised Cholesterol HEPATIC PPI
dose over two weeks as terhadap and Triglycerides, IMPAIRMENT Use
tolerated, to a maximal lansoprazole anorexia half normal dose in
dose of 800 mcg/day. moderate to severe
liver disease.
KELAS TERAPI
BAHAN AKTIF DOSIS KONTRA EFEK SAMPING PERHATIAN KHUSUS INTERAKSI
INDIKASI OBAT

Famotidine Adult: 20–40 mg twice Hipersensitif Constipation RENAL IMPAIRMENT Use Histamine H2-
daily for 6–12 weeks; fatigue, vomiting, normal dose every 36–48 antagonists
maintenance 20 mg twice anorexia, dry hours or use half normal dose
daily mouth, flatulence, if eGFR less than
nausea, taste 50mL/minute/1.73m2.
disorders Seizures reported very rarely

Ranitidine Adult: 150 mg twice Hipersensitif Blurred vision, RENAL IMPAIRMENT Histamine H2-
daily for 6 weeks, Alopecia, interstitial ▶ In adults Use half normal antagonists
alternatively 300 mg nephritis, dose if eGFR less than
once daily for 6 weeks, involuntary 50mL/minute/1.73m2. ▶ In
dose to be taken at nig movement children Use half normal
disorders, dose if estimated glomerular
pancreatitis filtration rate less than
50mL/minute/1.73m2
REFERENCE
• BNF 71ed.
• Dyspepsia and Gastro-oesophageal reflux disease. NICE clinical
guideline 184. 2014
• Management of Dyspepsia and Heartburn. Evidence-Based Best
Practice Guideline. New Zealand Guidelines Group. June 2004
• Symptoms in Pharmacy 6 ed.
• Monica D., Widi B. Diagnosis dan Tatalaksana Gastroesophageal
Reflux Disease (GERD) di Pusat Pelayanan Kesehatan Primer.
CDK-252/ vol. 44 no. 5 th. 2017
• Malone M. Managing dyspepsia. 2015