ANALGESIC

PHARMACOLOGY

Dani Kurniawan
1961B0001
Definisi :
01 Analgesik
Analgetika adalah zat-zat yang pada dosis
terapeutik menghilangkan atau menekan
rasa nyeri tanpa menyebabkan kehilangan
kesadaran.

02 Nyeri
Definisi nyeri yang dibuat IASP (International
Association The Study of Pain) yang berbunyi
“nyeri adalah pengalaman sensorik dan
emosional yang tidak menyenangkan akibat
kerusakan jaringan, baik aktual maupun
potensial, atau yang digambarkan dalam bentuk
kerusakan tersebut.”
Place Your Picture Here Mekanisme Nyeri

Fenomena nyeri timbul karena adanya kemampuan

sistem saraf untuk merubah berbagai stimuli, seperti
mekanikal, kemikal maupun termal (panas), menjadi
potensial aksi yang dijalarkan ke sistem saraf pusat.

Potensial aksi sebagai input di ssp, khususnya di

kornu dorsalis medula spinalis diolah secara
kompleks dan outputnya disalurkan ke ssp yang lebih
tinggi (otak) sehingga timbul persepsi nyeri
 Tujuan Penatalaksanaan Nyeri

Mengurangi intensitas Menurunkan

dan durasi keluhan nyeri kemungkinan berubahnya
nyeri akut menjadi gejala
nyeri kronis yang
persisten

Mengurangi penderitaan Meminimalkan reaksi tak Meningkatkan kualitas hidup pasien dan
dan ketidakmampuan diinginkan atau mengoptimalkan kemampuan pasien
akibat nyeri intoleransi terhadap terapi untuk menjalankan aktivitas sehari-hari
nyeri
Prinsip Penatalaksanaan Nyeri
Pengobatan nyeri harus dimulai dengan analgesik yang
paling ringan sampai ke yang paling kuat

Tahapannya :

 Tahap I analgesik non-opioit : AINS/ NSAID

 Tahap II  analgesik AINS + ajuvan

 Tahap III  Analgesik Opiat lemah + AINS + ajuvan

 Tahap IV  analgesik opiat kuat +AINS +ajuvan

.
ALLPPT
Layout

ONLINE DIAGNOSIS
Clean Text Analgesik

Slide
for your Non Narkotik

Presentation
Analgesik
Antipiretik Anti Inflamasi Non Steroid
Narkotik / opioid analgesik
Obat Pirai
 ANALGETIK NONNARKOTIK/
ANALGETIK PERIFER

Selain bersifat
analgesik juga
bersifat
05
Golongan ini sering
disebut juga dengan
AINS yakni Anti
antiinflamasi dan
antipiretik 04
Inflamasi Non
Steroid
03
02
Efektif untuk nyeri seperti
01 nyeri pada sakit kepala,
dismenore (nyeri menstruasi ),
Dipakai untuk nyeri pada inflamasi, abrasi
mengobati nyeri minor, nyeri otot dan artritis
ringan sampai ringan sampai sedang
Tidak bersifat sedang
adiktif
Mekanisme Kerja
 Golongan obat ini bekerja dengan cara menghambat
sintesa prostaglandin (PG).

 PG hanya beperan pada nyeri yang berkaitan dengan

kerusakan jaringan atau inflamasi

 PG menyebabkan sensitisasi reseptor nyeri terhadap

stimulasi mekanik dan kimiawi
 Analgetik Non Narkotik
SALISILAT
Aspirin, Magnesium Salisilat , Diflsinal

PARACETAMOL

ASAM PROPINOAT FENAMAT

Ibuprofen , Fenoprofen , Ketoprofen , Naproksen Asam Mefenamat , Meklofenamat

ASAM PIROLIZIN KARBOKSILAT ANTALGIN

Ketorolac

INHIBITOR COX-2 ASAM ASETAT

Celecoxib , Valdecoxib. Natrium Diklofenak
 PARACETAMOL
 Sebagai analgetik dan antipiretik yang baik
 Menghambat pembentukan prostaglandin secara sentral, namun tidak di
jaringan, sehingga tidak berefek sebagai anti-inflamsi
 Tidak memiliki efek antiplatelet
 Efek samping ringan dan jarang, relatif tidak menyebabkan gangguan lambung
 Dosis besar (6-12 gr) dapat menyebabkan kerusakan hati.
 Pada dosis terapinya merupakan pilihan yang aman bagi banyak kondisi
kesehatan, termasuk anak-anak dan ibu hamil/menyusui
 Konsentrasi tertinggi dalam plasma dicapai dalam waktu ½ jam dan t1/2 plasma
1-3 jam
 Paracetamol diekskresikan melalui ginjal
 Sediaan parasetamol berbentuk tablet 500 mg atau sirup yang mengandung 120
mg/5ml
 Dosis dewasa maksimum 4 g/hari, anak-anak maksimum 1,2 g/ hari. Untuk
anak 1-6 tahun :60-120 mg/kali dan bayi dibawah 1 tahun 60mg/kali ,
maksimum 6 kali sehari
 Nama Dagang : SANMOL ( Sanbe), PANADOL (Sterling), SISTENOL (Dexa
Medica), PAMOL (Interbat), OTTOPAN (Otto), PYREX ( Novell Pharma) dll
 Memiliki aktivitas analgetik, antipiretik dan anti imflamasi
ASETOSAL
 Memiliki efek antiplatelat sehingga dapat mencegah pembekuand darah. Sebaiknya tidak
digunakan pada pasien dengan gangguan pembekuan darah (mis hemofillia), sirosis hati,
trombositopenia atau pada pasca operasi
 Bersifat asam, dapat menyebabkan iritasi mukosa lambung. Sebaiknya jangan diminum
ketika lambung kososng. Tidak direkomendasikan bagi pasien yang memiliki riwayat
gangguan lambung
 Dapat menyebabkan Reye’s syndrome (suatu gangguan serius pada sistem hepatik dan
ssp), sebaiknya tidak digunakan pada anak-anak dibawah 12 tahun 20 % pasien asma
memiliki sensitivitas/alergi terhadap aspirin. Sebaiknya tidak digunakan pada pasien
dengan riwayat alergi (rinitis,urtikaria, asma, anafilaksis)
 Sebaiknya tidak digunakan pada wanita hamil karena dapat memperpanjang waktu
kelahiran dan meningkatkan resiko pendarahan pasca kelahiran (post-partum)
 Nama dagang : APTOR (Nicholas), ASCARDIA (Pharos), ASPILET ( Medifarma),
FARMASAL (Fahrenheit)
 Kadar tertinggi dicapai kira-kira 2 jam setelah pemberian
 Diekskresikan melalui ginjal, keringat dan empedu
 Dosis dewasa ialah 325-650 mg diberikan secara oral tiap 3 atau 4 jam. Untuk anak 15-
20 mg/kg BB diberikan 4-6 jam dengan dosis total tidak melebihi 3,6 g per hari
 ANTALGIN
Metampiron , Metamizole ASAM MEFENAMAT

• Memiliki efek analgetika,antipiretika dan

antinflamasi yang kuat
• Merupakan obat lama, memiliki efek samping yang
cukup berbahaya yaitu leukopenia dan
agranulositosis (penurunan jlh leukosit granular )
yang dapat berakibat kematian
• Nama Dagang : ANTALGIN BERLICO (Berlico
MuliaFarma), ANTALGIN HEXAFARM
(Hexafarm), CETALGIN (Soho), ANALSIK
(Kombinasi antalgin dan diazepam
DIKLOFENAK
 Sebagai analgetik dan antiinflamasi terutama untuk inflamasi
pada sendi seperti artritis rematoid, osteoartritis dll
 Absorpsi melalui saluran cerna berlangsung cepat
 T ½ singkat 1-3 jam
 Efek samping yang lazim ialah mual, gastritis, eritema kulit dan
sakit kepala
 Sebaiknya hati-hati untuk penderita tukak lambung
 Pemakaian selama kehamilan tidak dianjurkan
 Dosis dewasa 100-150 mg sehari terbagi 2 atau 3 dosis
 Nama Dagang : CATAFLAM (Novartis Indonesia), FLAMAR
(Sanbe), KAFLAM (Kimia Farma), KLOTAREN (Kimia Farma
 Memiliki khasiat analgetika, antipiretik dan
antiinflamasi yang cukup, tetapi tidak lebih kuat
daripada asetosal
 Bersifat asam, dapat menyebabkan gangguan
lambung. Sebaiknya jangan diminum pada saat
perut kososng, atau pada pasien dengan riwayat
gangguan saluran cerna/lambung.
 Efek samping : diare, trombositopenia,anemia
hemolitik dan ruam kulit
 Tidak direkomendasikan pada anak-anak dan
wanita hamil
 Sebaiknya tidak digunakan dalam jangka waktu
lebih dari seminggu, dan pada pemakaianlama
perlu dilakukan pemeriksaan darah
 Nama Dagang :LAPISTAN (Lapi),
MEFINAL(Sanbe), OPISTAN(Otto), PONSTAN
(Pfizer), PONDEX (Dexa Medica)
 Analgesik Narkotik
Do you need
an online
doctor now? o Merupakan kelompok obat yang memiliki sifat-sifat
seperti opium atau morfin

o Bekerja di susunan saraf pusat

o Reseptor tempat terikatnya opioid disel otak disebut

Reseptor opioid

o Obat yang mengantagonis efek opioid disebut

antagonis opioid

o Penggunaan terapi ; nyeri yang kuat hingga yang

paling kuat, nyeri tumor, nyeri yang disertai ketakutan
eksitensial
 Analgetik Narkotik / Opiat
ANTAGONIS SEPERTI METADON
Metadon , Propoksifen

AGONIS SEPERTI MEPERIDIN

ANTAGONIS
Meperidin , Fentanyl
Nalokson

AGONIS SEPERTI MORFIN ANALGESIK SENTRAL

Morfin , Hidromorfon , Oksimorfon , Tramadol
Kodein, Oksikordon , Hidrokordon
Mekanisme Kerja
 Bekerja pada reseptor opiat di SSPreseptor yang
memodulasi trasmisi nyerimenurunkan persepsi nyeri
dengan cara menyekat nyeri pada bebagai tingkat,
terutama di otak tengah dan medulla spinalis
 Reseptor opiat ada 3 :
 Reseptor μ (mu) : berperan dalam analgesia
supraspinal, depresi respirasi, euforia dan
ketergantungan
 Reseptor κ (kappa) : berperan dalam analgesia spinal,
miosis, sedasi
 Reseptor δ (delta) : disforia, halusinasi, stimulasi
pusat vasomotor
 Contoh Obat Golongan Opiat
PETHIDIN
MORFIN
o Efektivitas lebih besar dibandingkan dengan kodein
 Digunakan sebagai obat pilihan pertama untuk o T ½ 4jam, durasi analgetiknya 3-5 jam
nyeri sedang sampai berat oEfek puncak tercapai dalam 1 jam (injeksi) atau 2 jam
 Dapat diberikan secara oral, parentral atau rektal (oral)
 Efek samping : depresi respirasi (kombinasi o Diberikan secara i.m atau oral
dengan alkohol atau depresan ssp), mual-muntah, o Efek sampingnya setara morfin
konstipasi, pruritis, merah dan panas pada flush o Penggunaan terapi ; infark miokard akut, serangan
area glaukoma akut, pramedikasi, nyeri pasca bedah, kejang
 Metabolisme di hati a( kejang his, saluran lambung usus, sistem urogenital,
 Hati-hati pada kehamilan karena morfin dapat pembuluh darah)
melewati sawar uri dan mempengaruhi janin o Eliminasi melalui ginjal
 Ekskresi morfin melalui ginjal, feses dan keringat oNama Dagang : PETIDIN ( Kimia Farma)
 Nama Dagang : MST CONTINUS (MBF)

KODEIN
o Digunakan untuk nyeri ringan sampai sedang
o T ½ 3 jam, efikasi 1/10 morfin. TRAMADOL
o Ketergantungan lebih rendah o Digunakan untuk nyeri sedang sampai kuat oleh berbagai
o Dosis oral 30 mg setara dengan aspirin 325-600 mg penyebab akut dan kronis
o Dosis kodein untuk antitusiv adalah 10 mg untuk orang o Lama kerja 6 jam, intensitas 1/5 – 1/10 morfin
dewasa o T ½ 6 jam
o Nama Dagang : CODITAM (Kimia Farma), o Metabolisme dalam hati
CODIPRONT (Kimia Farma), CODIPRON CUM EXP o Eliminasi melalui ginjal
(Kimia Farma) o Efek samping lebih ringan daripada morfin, sedikit hingga
sama sekali tidak ada depresi pernafasan
o Nama Dagang : TRAMAL (Pharos), KAMADOL (Kimia
Farma), FORGESIK (Bernofarm), TRAGESIK (Kalbe Farma),
TRADOSIK (Sanbe), TRUNAL DX (Ferron) dll
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