FARMAKOLOGI OBAT SISTEM RESPIRATORORIUS

Setyawati SK
Farmakologi FKUB

PENDAHULUAN
Penyakit yang banyak terjadi pada sistem respiratorius berkaitan dengan pernafasan dan fungsi paru, misal : Infeksi saluran nafas Alergi Inflamasi Obstruksi jalan nafas (asma dan penyakit paru obstruksi menahun/ PPOM lainnya)

 Obat-obat yang bekerja pada sistem respiratorius Antihistamin Saluran nafas atas Nasal dekongestan Simptomatik Obat batuk & mukolitik Bronkhodilator Kortikosteroid Saluran nafas bawah Kromoglikat Antagonis Leukotrien

ANTIHISTAMIN
Digunakan untuk alergi nasal Antihistamin generasi I sedasi Chlorpheniramin maleat (chlortrimeton=ctm) Diphenhydramin (delladryl, benadryl) Prometazin (Phenergan) Antihistamin generasi II non sedasi Loratadin Terfenadin Cetirizin

Efek Samping
Generasi I Sedasi Mulut kering Mata kabur Gangguan GI Sakit kepala Retensi urin Generasi II Sedikit sedasi Interaksi dng antifungi, antibiotik, obat prokinetik, Potensial gangguan jantung

Dekongestan
Simpatomimetik Agonis adrenergik Ephedrin, pseudoephedrin Phenylpropanolamin (PPA) Phenylephrin vasokonstriksi mukosa & sekresi berkurang hidung longgar Efek Samping ? Topikal tetes, semprot

Dekongestan
Nursing alerts: Overuse of topical nasal decongestants can cause rebound congestion, meaning that the congestion can be worse with the use of drug. To minimise this, drug therapy should be discontinued gradually. The use of topical agents is limited to no more than 3 to 5 days The patients blood pressure and pulse should be assessed before a decongestant is administered Inform the patient that nasal burning and stinging may occur with topical decongestants

ANTITUSIF
Menekan reflex batuk di pusat batuk /SSP Indikasi : batuk non produktif/ iritasi Contoh obat : - narkotik kodein - non narkotik noskapin dekstrometorphan Efek samping : - depresi - konstipasi (narkotik) Kontraindikasi : ?

 Nursing Alerts: Observe for excessive suppression of the cough reflex (inability to cough effectively when secretions are present). This is a potentially serious adverse effect because retained secretions may lead to lungs collapse, pneumonia, hypoxia, hypercarbia, and respiratory failure

EKSPEKTORAN
Merangsang pengeluaran sekret/ mukus batuk Indikasi batuk produktif Contoh obat : - Ipekak - Amonium klorida (NH4Cl) - Gliseril guaiakolat Mukus kental, kuning mukolitik antibiotik Kontraindikasi ?

MUKOLITIK
Mengencerkan sekret sal.nafas memecah mukoprotein & mukopoliskarida sputum Contoh obat : - bromheksin - ambroxol - asetilcystein

OBAT-OBAT ASMA BRONKHIALE

PATOFISIOLOGI ASMA BRONKHIALE Penyakit inflamasi sal.nafas

(sel-sel inflamasi) Gejala - hiperresponsif bronkhus thd stimuli penyempitan bronkhus Gamb.patologi * bronkhokonstriksi * penebalan mukosa ok edema & infiltrasi sel * sekresi mukus >

Ag (polutan, alergen)

Ag-Ab/IgE di mast cell MEDIATOR

Late response : Inflamation Hyperreactivity

Early response : Bronchoconstriction Symptom

TERAPI

Ag (polutan, alergen) hindari

Ag-Ab/IgE di mast cell kromolin, steroid

MEDIATOR steroid agonis , teofilin, anti kholinergik Late response : Early response : Inflamation Bronchoconstriction Hyperreactivity Symptom

TERAPI
1. BRONKHODILATOR 2. ANTIINFLAMASI 3. LAIN-LAIN * mukolitik * antitusif, ekspektoran ? * antihistamin * antibiotik jk.perlu * preventif kromolin steroid

CATATAN : JIKA HIPOKSIA (pd status asmatikus) OKSIGEN

BRONKHODILATOR
1.SIMPATOMIMETIK/ ADRENERGIK - adrenalin/ epinefrin - efedrin - isoproterenol, isoprenalin - agonis 2 selektif 2. DERIVAT XANTIN - teofilin Phosphodiesterase inhibitor cAMP me ningkat relaksasi otot polos bronkus

3. ANTIKHOLINERGIK - atropin - ipatropium bromid

Agonis adrenergik 2 selektif

- Terbutalin (Allupent) - Albuterol (Salbutamol) - Metaproterenol efektif pd - Fenoterol serangan akut - Formoterol Selektivitas pada reseptor adr.2 Efektif pd pemberian -p.o. -aerosol onset cepat langs.reseptor

Efek samping
-aritmia ok stimulasi 1 jantung -tremor, musc.cramps -gangguan metabolisme -iritasi pada penggunaan inhaler -penggunaan lama reseptor desensitif

tolerans

Nursing Alerts When 2 or more puffs are needed, inform the patient that at least 1 minute should be allowed between puffs Inform the patient that salmeterol and formoterol, and oral -2 agonists should be taken on a fixed schedule, not on a prn basis Instruct the patient to report chest pain and changes in heart rhythm or rate, because -2 agonists can cause cardiac stimulation Contact physician if symptoms such as nervousness, insomnia, restlessness and tremor become severe

DERIVAT XANTIN
METYLXANTIN TEOFILLIN TEOBROMIN CAFFEIN

EFEK

- Relaksasi otot polos bronkhus - Stimulasi SSP - Stimulasi otot jantung - Diuresis - Asam lambung

FARMAKOKINETIK
- absorpsi baik : - p.o., sustained release kadar stabil di plasma - p.e. iv - distribusi : slrh tubuh plasenta, ASI - metabolisme: hepar ok -induksi enz o/ rifampin, fenobarbtal, etanol -rokok ok -inhibisi enz o/ simetidin, eritromisin, alopurinol -gagal jantung, liver dis. -orang tua

EFEK SAMPING
-iv.cepat aritmia jantung, hipotensi -Sakit kepala, palpitasi, dizziness, nausea, hipotensi, nyeri prekordial -Indeks terapi sempit dosis besar takikardia, agitasi kejang, emesis, Gx.GIT -Anak-2 mudah kejang

 Nursing alerts: Plasma theophylline levels should be monitored to keep it in the therapeutic range, usually 5-15 g/ml. Dosage should be adjusted to keep theophylline levels below 20 g/ml If patients miss a dose, the following dose should not be doubled Instruct the patient that sustained-release formulations should be swallowed intact Caution patients in consuming caffeine containing-beverages and other sources of caffeine. Caffeine can intensify the adverse effects and decrease the metabolism of theophylline

ANTIKHOLINERGIK
*ATROPIN : iv; aerosol *IPATROPIUM BROMID : aerosol

Mekanisme : -Antagonis res.kholinergik M # otot polos bronkhodilatasi # kelenjar mukus Efek sistemik : -Mulut kering, retensi urin, mata kabur, takikardi Efektif u/ hiperreaktif bronkhokonstriksi PPOM, bronkhitis kronis, orang tua

ANTIINFLAMASI
KORTIKOSTEROID

EFEK : -langsung otot polos bronkus (-) -inflamasi -hiperreaktivitas -efek pd reseptor adr. : kepekaan
Obat : prednison, prednisolon mild asma : inhaler p.o

EFEK SAMPING

-lokal : kandidiasis, iritasi

-sistemik : supresi adrenal retensi Na dan air osteophorosis ulkus peptikum metab. KH moon face, buffalo hump

 Nursing alerts Rinse mouth with water without swallowing after administration to reduce the risk of candidiasis If taking bronchodilators by inhalation, use bronchodilators several minutes before the corticosteroid to enhance application of the corticosteroid into the bronchial tract

KROMOLIN
-per inhalasi

-stabilisasi mast cell degranulasi (-) -efek samping : . Batuk, edem laryng, nyeri sendi, sakit kepala, rash, nausea -indikasi : - preventif serangan asma Contoh ketotifen

 Nursing Alerts : Cromoglycates are for long-term prophylaxis, patients should administer on a regular schedule & the full therapeutic effects may take several weeks to develop They are contraindicated in patients who are hypersensitive to the drugs