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D R . P A T O N A H , M S I . , A P T

FARMAKOTERAPI

MATERI KULIAH FARMAKOTERAPImateri keterangan

1 hipertensi kardiovaskular

2 gagal jantung kardiovaskular

3 aritmia kardiovaskular

4 hiperlipidemia kardiovaskular

5 asma respirasi

6 tukak peptik dan GERD sal cerna

7 pankreatitis sal cerna

8 drug induced liver desease sal cerna

9 gagal ginjal (akut/kronis) ginjal

10 drug induced kidney desease ginjal

11 multiple sclerosis neurologic

12 epilepsi neurologic

13 parkinson neurologic

14 sakit kepala neurologic

15 eating disorder psikiatrik

16 alzheimer psikiatrik

17 sleep disorder psikiatrik

18 diabetes mellitus endokrinologi

19 penyakit tiroid endokrinologi

20 sistemik lupus eritematosus imunologi

21 osteoporosis rheumatologi

22 osteoarthritis rheumatologi

23 gout hiperurikemia rheumatologi

24 rheumatoid arthritis rheumatologi

25 psoriasis dermatologi

26 drug induced hematologi disorder hematologi

27 infeksi saluran urin penyakit infeksi

REFERENSI /PUSTAKA/RUJUKAN MATERI KULIAH

PHARMACOTHETAPY -PATHOPHYSIOLOGIACL APPROACH DI PIRO 2008

GODMAN GILMAN HANDBOOK MANUAL PHARMACOLOGY THERAPEUTIC

STOCKLEY DRUG INTERACTION 2008

Dipiro- Pharmacotherapy-Handbook

ISO FARMAKOTERAPI

MEYLER SIDE EFFECT OF DRUGS VOL 30 TH 2008

HARISON: INTERAL MEDICINE

PENDAHULUAN

FARMAKOTERAPI?

FARMAKOEKONOMI

Identifikasi, mengukur dan membandingkan biayayg diperlukan dan konsekuensi terapi obat dalam

sistem pelayanan kesehatan

Biaya kesehatan:

direct medical

Direct non medical

Intangible

Pertimbangkan: outcome klinik dan ekonomi

Pertimbangan Farmakoekonomi

Cost efektifitas

Cost benefit

Cost minimalisasi

Membandingkan berbagai pilihan terapi denganbiaya yg dikeluarkan dgn memperhatikan outcome terapi kualitas hidup pasien

TERAPI PASIEN INDIVIDUAL

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outcome terapi

Kematian

Penyakit

Disability

Ketidaknyamanan

ketidakpuasan

3 kategori outcome

Ekonomi

Klinik

Humanistik (patients reported outcome)

Evidence based medicine

Suatu pendekatan pemilihan obat berdasarkanpenelitian klinik yg terkontrol (randomized

controlled trials)

Pharmaceutical care

Dokumentasi intervensi farmasis

Farmakokinetik dan farmakodinamik klinik

Farmakokinetik: absorpsi, distribusi, metabolisme, eliminasi obat pd pasien yg diterapi

Farmakodinamik: hubugan antara konsentrasi obat

dengan respon pasien krn dosis yg sama bsmenghasilkan konsentrasi yg berbeda pd individukrn perbedaan profil farmakokinetiknya

Farmakogenetik

Variasi genetik berperan dlm menghasilkan responobat yg berbeda pd tiap individu

Variasi genetik: mempengaruhi metabolisme obat,

transporter obat, dan protein target obat

Variasi genetik berkaitan dengan efikasi dan

toksisitas obat

Variasi genetik dalam enzim yg memetabolismeobat: CYP450

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Polimorfisme gen transporter obat

P-glikoprotein:

MDR-1: multidrug resisten

ABC (ATP-binding casette)

Vitamin K epoksida reduktase: resistensi thd warfarin, perlu

dosis tinggi utk efeknya

angiotensin converting enzyme (ACE): resisten thd efek obathipertensi golongan ACE inhibitor

Wanita hamil / menyusui

Altered drug pharmacokinetics during pregnancy can influence drug selection and dosing. Physiologic changes during pregnancy result in changes in absorption, protein binding, distribution, and elimination.

Although drug-induced teratogenicity is a serious concern during pregnancy, most drugs required by pregnant women can be used safely.

Pregnancy-influenced health issues, such as constipation, gastroesophageal reflux disease, and nausea/vomiting, have been treated safely and effectively with carefully selected drug therapy. Some acute and chronic illnesses pose special risks during pregnancy and should be treated with appropriately selected and monitored drug therapies to avoid harm to both the woman and the fetus.

Pediatrik

Bukan orang dewasa kecil

Fungsi organ yg belum sempurna

Berbeda dalam absorpsi, distribusi, metabolisme daneliminasi dgn orang dewasa

Contoh: waktu pengosongan lambung lambat pd bayi prematur (obat yg terbatas absorpsinya pd org

dewasa akan efektif terabsorpsi pd bayi)

Lemak tubuh bayi lbh sedikit dibanding dewasa: volume distribusi obat larut lemak lbh kecil drdewasa

Geriatrik

Populasi usia di atas 65 tahun

Penurunan fungsi fisiologis krn usia mempengaruhifarmakokinetik dan farmakokinetik bbg obat

Sring terjadi masalah berkaitan obat danmeningkatnya morbiditas

Farmasis berperan dlm optimasi terapi obat dan

menghindari/mencegah masalah berkaitan obat