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Dara Ugi

FK Unismuh Makassar
2017
PENGERTIAN UMUM
FARMASI : ilmu pembuatan dan penyediaan obat

FARMAKOLOGI : ilmu pemakaian & pengembangan obat


pada manusia

FARMAKOLOGI KLINIK : ilmu farmakologi yang mempelajari


pengaruh kondisi klinis pasien terhadap efikasi obat, misalkan
kondisi hamil dan menyusui, neonatus dan anak, geriatri, inefisiensi
ginjal dan hepar.

FARMAKOTERAPI : cara memilih & memakai obat dalam


terapi -> patient oriented

FARMAKOEPIDEMIOLOGI : penggunaan obat di tengah masyarakat


-> community oriented
Aims of Pharmacology (Basic & Clinical)
The fundamental problemes with which pharmacology
is concerned are following:
• 1). The relationship between dose and biological
effect;
• 2). The localization of the site of action of a drug;
• 3). The mechanism (s) of action of drug;
• 4). The absorption, distribution, metabolism, and
excretion of a drug (PK);
• 5). The relationship between chemical structure and
biological activity;
The aims and goals of Clinical Pharmacology
Clinical pharmacologists are concerned both:
I. Optimal use of existing medications;
II. Scientific study of drugs in humans;

The latter area include both evaluation of:


1).The safety and efficacy of currently available drugs;
2). Development of new and improved pharmacotherapy
(this is the main goal of Clinical Pharmacology);
The newly available drugs must be safety and efficacy
too;
OBAT & PROSES FARMAKOLOGI
Obat ber”muka dua”
MANFAAT : Satu jenis obat dapat
mendatangkan satu atau lebih efek yang
menguntungkan untuk keperluan medikasi
MUDHARAT : obat memiliki berbagai macam
efek yang dapat merugikan ; ringan sampai berat
(side effects & adverse effects)

OBAT = RACUN
“aman” jika digunakan dengan kaidah hukum
Farmakologi (Klinik)
PENGERTIAN UMUM
Clinical Pharmacology is the scientific discipline
that involves all aspects of the relationship
between drugs and humans
discovery and development of new drugs
the application of drugs as therapeutic agents
the use of drugs
the beneficial and harmful effects of drugs in
individuals and society
and the deliberate misuse of drugs
Clinical Pharmacology
Multidisciplinary team :
Medicine
Pharmacology
Pharmacy
Biomedical
Nursing
etc (economists, epidemiologists, toxicologists)
Half-life

Time required for the body to eliminate 50% of


the drug
Plan the frequency of dosing
Drugs with short half-life: Administered
frequently
Drugs with long half-life: Require less frequent
dosing
*Difficulty in drug excretion: Increases half-life
and risk of toxicity
Onset, Peak, and Duration

Onset of action: Time between drug


administration and beginning of
therapeutic effect
Peak concentration: Absorption rate
equals elimination rate
Duration of action: Time for drug to
produce therapeutic effect
Pharmacodynamic Phase
Pharmacodynamics: Study of drug
mechanisms producing
biochemical/physiologic changes in body
Primary effect of drug: Desired or therapeutic
effect
Secondary effect of drug: Other desirable or
undesirable effects
Drugs exert action - two mechanisms:
Alteration in cellular form/environment
Receptor-mediated Drug Action
Drug interacts with receptor; function of a
cell alters; drug molecule joins with reactive
site (receptor) on surface of cell
Agonist: Binds with and stimulates receptor
- therapeutic response
Antagonist: Joins with but does not
stimulate receptors; prevents drug
response; competitive/noncompetitive
Effects of number of available receptor sites;
potent drugs
Drug Use and Pregnancy
Drugs administered during the first
trimester: May cause teratogenic effects
 Most drugs: Contraindicated unless benefits
outweighs risk
Pregnant women: Use drugs/herbal
supplements only after consultation
Risks of smoking and drinking: Low birth
weight; premature birth; fetal alcohol
syndrome
Addictive drugs: Children born with
addiction
Such as cocaine or heroin
Various Drug Reactions

Allergic drug reactions


Drug idiosyncrasy
Drug tolerance
Cumulative drug effect
Toxic reactions
Pharmacogenetic reactions
Allergic Drug Reactions (Hypersensitivity
Reactions)
*Usually begins after more than one dose of the
drug is given; body views drug as antigen
Signs and symptoms: Itching; skin rashes; hives;
wheezing; cyanosis; sudden loss of
consciousness; swelling of eyes, lips, or tongue
Anaphylactic shock; hypotension and shock;
*angioedema, dyspnea, urticaria
Angioedema most often occurs around the eyes,
lips, mouth and throat
Drug Idiosyncrasy
Unusual, abnormal reaction to drug; different
from expected reaction
Cause: Believed to be due to genetic deficiency

Drug Tolerance
• *Decreased response to a drug: Requires
increased dosage for desired effect
• Example: Narcotics or tranquilizers taken for
a long time
Cumulative Drug Effect
Patients with liver and kidney disease: Body is unable
to metabolize and excrete one dose of drug before
next dose is given
Dose lowered to prevent toxic drug reaction

Toxic Reactions
• *Drug is administered in large dosages; blood
concentration levels exceed therapeutic levels
• Reverse drug toxicity: Administer another drug as
antidote; monitor drugs with low safety margin
Drug Interactions

One drug interacts and interferes with the


action of another drug
Oral anticoagulants; oral hypoglycemics;
anti-infectives; antiarrhythmics; cardiac
glycosides; alcohol
Effects: Additive; synergistic; antagonistic
Additive Drug Reaction
Combined effect of two drugs is equal to sum of
each drug given alone (1 + 1 = 2)
Synergistic Drug Reaction
• *Drug synergism: Drugs interact with each
other and produce a sum greater than the
sum of their separate actions (1 + 1 = 4)
Antagonistic Drug Reaction
• One drug interferes with action of another:
Neutralization/decrease in effect of one drug
Drug-food Interactions
Food may impair or enhance its absorption
Drug taken on empty stomach (captopril)
Drugs that irritate stomach; cause nausea;
vomiting; epigastric distress: Given with
meals (anti-inflammatory drugs;
salicylates)
Drug–food mixture: Drugs combine with a
drug forming an insoluble food
(tetracycline administered with dairy
products)
*Factors Influencing Drug Response

Age
Weight
Gender
Disease
Route of administration
Special issues
Perinatal & Pediatric pharmacology :
Pregnancy
Perinatal
Geriatric

GI diseases

Dermatologic diseases -> skin as complex series


of diffusions barriers
Pregnancy
Lipid Solubility

Molecular size & pH

Placental transporter
Pharmacokinetics
Protein binding

Placental & fetal drug metabolism


placenta as semi-permeable barrier
Umbilical veins enter fetal liver
Pregnancy
Maternal drugs action

Therapeutic drug actions in the fetus

Corticosteroids -> lung


Phenobarbital -> hepar
Antiarrhythmic -> heart
Pharmacodynamics
Teratogenics :

Malformation
IUGR
Miscarriage
Neurocognitive delay
Infants & Children
Absorption : blood flow, GI function

Distribution : water composition

Metabolism : hepatic system

Excretion : GFR
Geriatrics
Pharmacological changes :
A : diet, gastric emptying rate
D : reduced body water, increased fat, decreased
albumin
M : indirect effect, ie. ability to recover from
injuries, disease, etc.
E : Creatinine clearance
Pharmacodynamics changes :
“more sensitive”
Behavioral & life style changes
CONTOH SOAL
Seorang perempuan berusia 60 tahun dibawa ke unit gawat darurat
RS oleh keluarganya dengan keluhan penurunan kesadaran sejak
10 menit yang lalu. Pada anamnesis diketahui terdapat riwayat
nafsu makan menurun dan lemas, riwayat penyakit Hipertensi sejak
10 tahun yang lalu, dan berobat dengan Captopril 3 x 25 mg/hari
tanpa kontrol dokter teratur. Pada saat dilakukan pemeriksaan fisis
pasien sudah dapat membuka mata spontan, tekanan darah 90/50
mmHg, denyut nadi 57x /menit, frekuensi nafas 18x/menit,
temperature 36,7C. Manakah cabang ilmu farmakologi berikut yang
terkait dengan kasus pasien ini ?

A. Farmakologi klinik

B. Farmakodinamik ==

C. Farmakokinetik

D. Farmakogenetik

E. Toksikologi
Apakah ilmu yang mempelajari tentang efek
racun dari obat terhadap tubuh yang dapat
menimbulkan penyakit atau kematian

A. Farmakognosi

B. Farmakokinetik

C. Toksikologi ==

D. Farmakologi

E. Farmakodinamik
Apakah faktor berikut ini yang mempengaruhi
absorbsi suatu obat ?

A. Kelarutan, konsentrasi,Luas permukaan obat,


Bentuk obat ==

B. Kelarutan, Luas permukaan obat, pH Urin,


Enzim

C. Konsentrasi, kelarutan, Enzim, Jenis obat

D. Konsentrasi, Usia, Bentuk obat, Jenis obat

E. Bentuk obat, Kelarutan, usia, pH urin


Seorang perempuan berusia 34 tahun dibawa ke UGD
dengan keluhan utama sesak sejak 1 hari yang lalu.
Pada anamnesis diketahui terdapat riwayat penyakit
asma bronchial sejak 4 tahun yang lalu. Berdasarkan
anamnesis dan pemeriksaan fisis dokter kemudian
memberikan terapi teofilin intravena karena melihat
serangan asma yang dialami pasien sangatlah berat.
Manakah cabang ilmu farmakologi berikut yang sesuai
dengan kasus pasien ini ?
A. Farmakologi klinik
B. Farmakodinamik
C. Farmakokinetik ==
D. Farmakogenetik
E. Toksikologi
Cara pemberian yang cepat menimbulkan efek
suatu obat:

A. Intra muskuler

B. Suppositeria

C. Topikal

D. Sublingual==

E. Intraperitonium