Farmakologi Obat Pada Reaksi Hipersensitivitas

8/19/2019 Farmakologi Obat Pada Reaksi Hipersensitivitas

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FARMAKOLOGIFARMAKOLOGI OBATOBAT PADAPADAREAKSIREAKSI

HIPERSENSITIVITASHIPERSENSITIVITAS

Noor Wijayahadi


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Classii!a"io#Classii!a"io#

Coombs and Gell classificationCoombs and Gell classification

1-Type I - immediate ( atopic, or anaphylactic)2-Type II - antibody-dependent sitotoksik

anemi hemolitik

3-Type III - immune comple serumsickness

!-Type I" - cell-mediated or delayed


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Allergy

Ig E mediated(Type Ihypersensitivity)

Non Ig Emediated


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Tr$a"%$#" a&&roa!h$s or I'E(%$dia"$d All$r'y


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T$ra&iT$ra&i

ANTAGONIS KIMIAWI ANTAGONIS KIMIAWI

) ANTI HISTAMIN ANTI HISTAMIN

) STEROIDSTEROID

ANTAGONIS F*NGSIONAL ANTAGONIS F*NGSIONAL

) Bro#+odila"orBro#+odila"or

adr$#ali#adr$#ali#


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PENGELOLAAN S,OK ANAFILAKTIKPENGELOLAAN S,OK ANAFILAKTIK

POSISI S,OKPOSISI S,OK

ABC -Air.ay(Br$a"hi#'( Cir!/la"io#0 ABC -Air.ay(Br$a"hi#'( Cir!/la"io#0

VASOKONSTRIKTORVASOKONSTRIKTOR ADRENALIN ADRENALIN

CEGAH REAKSI LAN1*TANCEGAH REAKSI LAN1*TAN STEROIDSTEROID S*PORTIF2S*PORTIF2

) CAIRANCAIRAN

) OKSIGENOKSIGEN

NB2 MASA KER1A ALERGEN 3s OBATNB2 MASA KER1A ALERGEN 3s OBAT


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CorticosteroidsCorticosteroids

45 I%/#od$&r$sa#45 I%/#od$&r$sa#

65 A#"i(i#la%asi65 A#"i(i#la%asi


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#entuk $ediaan#entuk $ediaan

GlucocorticoidsGlucocorticoids$hort actin%$hort actin%

Intermediate actin%Intermediate actin%

&on% actin%&on% actin%

'ineralocorticoids'ineralocorticoids

Inhalant steroidsInhalant steroids

Topical steroidsTopical steroids


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harmacokineticsharmacokinetics

bsorptionbsorption** all areall are rapidly + completelyrapidly + completely absorbedabsorbed

TransportTransport** Transcortin .Transcortin .

lbumin .lbumin .

/ree form 20./ree form 20.

'etabolism'etabolism**

by lier enymes, conu%ation + ecretion by urineby lier enymes, conu%ation + ecretion by urine partly ecreted as 1-ketosteroids4partly ecreted as 1-ketosteroids4

tt152152 of cortisol 14 hoursof cortisol 14 hours


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$hort ctin% Glucocorticoid (t152 6 12 h)$hort ctin% Glucocorticoid (t152 6 12 h)

7ru%7ru% nti-inflam4nti-inflam4 $alt retainin%$alt retainin% reapartions + dosereapartions + dose

CortisolCortisol 11 140140 m% tablet m% tablet

100 m%5ial (i4m4, i4)100 m%5ial (i4m4, i4) Topical8 enemaTopical8 enema

CortisoneCortisone 049049 049049 m% tablet m% tablet

2 m%5ial (i4m)2 m%5ial (i4m)

Intermediate ctin% GlucocorticoidIntermediate ctin% Glucocorticoid (t(t152152 : 12 -3; h): 12 -3; h)

rednisonerednisone !! 049049 ((

rednisolonerednisolone 043043 , 10 m% tablet, 10 m% tablet

20 m%5ial (i4m, intrarti)20 m%5ial (i4m, intrarti)

'ethyl'ethyl

prednisoloneprednisolone

00 04, 140 %m in4 for i4m404, 140 %m in4 for i4m4

or slo< i44or slo< i44

TriamcinoloneTriamcinolone 00 ! m% Tab4,! m% Tab4,

10, !0 m%5ml for i4m4 +10, !0 m%5ml for i4m4 +

intrarticular in4intrarticular in4


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7ru%7ru% nti-nti-inflam4inflam4

$alt retainin%$alt retainin% reapartions + dosereapartions + dose

&on% ctin%&on% ctin% GlucocorticoidGlucocorticoid (t(t152152 = 3; h)= 3; h)

7eamethasone7eamethasone 22 00 04 m% tab404 m% tab4!m%5ml in (i4m4, i44)!m%5ml in (i4m4, i44)

#etamethasone#etamethasone 22 00 04, 1 m% tab404, 1 m% tab4

!m%5ml in (i4m4, i44)!m%5ml in (i4m4, i44)

aramethasonearamethasone 1010 00 2- 20 m%5day (oral)2- 20 m%5day (oral)


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'ineralocorticoids -'ineralocorticoids - reparationsreparations

7ru%7ru% nti-nti-inflammatoryinflammatory

$alt retainin%$alt retainin% reapartions +reapartions +dosedose

/ludrocortisone/ludrocortisone 1010 1010 100 mc% tab4100 mc% tab4

7>C7>C 00 100100 24 m%24 m%sublin%ualsublin%ual

ldosteroneldosterone 043043 30003000 ?ot used?ot usedclinicallyclinically


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I#hala#" S"$roids2 Bro#!hial As"h%aI#hala#" S"$roids2 Bro#!hial As"h%a

#eclomethasone#eclomethasonedipropionatedipropionate

0,100,200 mc%5md inhaler 0,100,200 mc%5md inhaler

100, 200, !00 mc% @otacaps100, 200, !00 mc% @otacaps

/luticasone/luticasonepropionatepropionate

2, 0 mc%5md inhaler 2, 0 mc%5md inhaler

2,0,125md '7I2,0,125md '7I

0, 100, 20 mc% @otacaps0, 100, 20 mc% @otacaps

#udesonide#udesonide 100,200 mc%5md inhaler 100,200 mc%5md inhaler 042, 04 m%5ml respules042, 04 m%5ml respules


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7ru%7ru% Topical preparationTopical preparation otencyotency

#eclomethasone#eclomethasone

dipropionatedipropionate

0402 . cream0402 . cream otentotent

#etamethasone benoate#etamethasone benoate+ #4 alerate+ #4 alerate

0402 . cream, ointment0402 . cream, ointment

0412 . cream, ointment0412 . cream, ointment

otentotent

Clobetasol propionateClobetasol propionate 040 . cream040 . cream otentotent

AalcinonideAalcinonide 041 cream041 cream otentotent

Triamcinolone actonideTriamcinolone actonide 041 . ointment041 . ointment otentotent

/luocinolone actonide/luocinolone actonide 0402. ointment0402. ointment 'oderate'oderate

'ometasone'ometasone 041 . cream, ointment041 . cream, ointment 'oderate'oderate

/luticasone/luticasone 040 . cream040 . cream 'oderate'oderate

Aydrocortisone acetateAydrocortisone acetate 24 . ointment24 . ointment 'oderate'oderate

Aydrocortisone acetateAydrocortisone acetate 041 B 140. ointment041 B 140. ointment 'ild'ild

Topical steroids


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Topical $teroidsTopical $teroids

#enefits due to anti-inflammatory, immunosuppressie,

asoconstrictor and anti-proliferatie actions

Good r$s&o#s$Good r$s&o#s$ Slo. r$s&o#s$Slo. r$s&o#s$

topic ecema,topic ecema,

ller%ic contact dermatitis,ller%ic contact dermatitis,

&ichen simple,&ichen simple,

rimary irritant dermatitis,rimary irritant dermatitis,

$eborrheic dermatitis,$eborrheic dermatitis,

soriasis of face,soriasis of face,

"aricose"aricose ecemaecema

Cystic acneCystic acne

lopecia areatalopecia areata

7iscoid &7iscoid &

Aypertrophied scarsAypertrophied scars

DeloidsDeloids&ichen planus&ichen planus

soriasis of palm, sole,soriasis of palm, sole,

elbo< + kneeelbo< + knee


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Topical $teroidsTopical $teroids

enetration differs at different sites*enetration differs at different sites*

Ai%h*Ai%h* ailla, %roin, face, scalp, scrotumailla, %roin, face, scalp, scrotum'edium*'edium* limbs, trunklimbs, trunk

&o


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Therapeutic principlesTherapeutic principles

Dos$ s$l$!"io#Dos$ s$l$!"io# 7y "rial 8 $rror9 N$$ds7y "rial 8 $rror9 N$$dsr$:/$#" $3al/a"io#r$:/$#" $3al/a"io#

Si#'l$ dos$Si#'l$ dos$2 No har%2 No har%

F$. days "h$ra&yF$. days "h$ra&y /#li+$ly "o 7$ har%/l/#li+$ly "o 7$ har%/l I#!id$#!$ o sid$ $$!"sI#!id$#!$ o sid$ $$!"s r$la"$d "o d/ra"io#r$la"$d "o d/ra"io#o "h$ra&yo "h$ra&y

*s$ is*s$ is o#ly &allia"i3$o#ly &allia"i3$ -$;!$&" r$&la!$%$#"-$;!$&" r$&la!$%$#""h$ra&y0"h$ra&y0

A7r/&" !$ssa"io# A7r/&" !$ssa"io# o &rolo#'$d hi'h dos$o &rolo#'$d hi'h dos$l$ads "o adr$#al i#s/i!i$#!yl$ads "o adr$#al i#s/i!i$#!y

--!o#"rai#di!a"$d!o#"rai#di!a"$d00


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$iklus $irkadian$iklus $irkadian


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Goal o "h$ra&y2Goal o "h$ra&y2To reliee pain or distressin% symptom (e4%4,To reliee pain or distressin% symptom (e4%4,

rheumatoid arthritis)*rheumatoid arthritis)* start


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&on%er the duration of therapy, slo


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derse reactions (152)derse reactions (152)

'etabolic toicity*'etabolic toicity* ) Ia"ro'$#i! C/shi#'


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derse reactionsderse reactions (252)(252)

A ais suppressionA ais suppression #ehaioral toicity*#ehaioral toicity* E/&horia= &sy!ho%o"orE/&horia= &sy!ho%o"or

r$a!"io#s= s/i!idal "$#d$#!yr$a!"io#s= s/i!idal "$#d$#!y

>cular toicity*>cular toicity* s"$roid i#d/!$d 'la/!o%a=s"$roid i#d/!$d 'la/!o%a= &os"$rior s/7!a&s/lar !a"ara!"5&os"$rior s/7!a&s/lar !a"ara!"5

>thers*>thers* ) $uperinfections$uperinfections

) 7elayed


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ContraindicationsContraindications

I#$!"io#sI#$!"io#s

Hy&$r"$#sio# .i"h CCFHy&$r"$#sio# .i"h CCF

Psy!hosisPsy!hosis

P$&"i! /l!$r P$&"i! /l!$r

Dia7$"$s %$lli"/sDia7$"$s %$lli"/s Os"$o&orosisOs"$o&orosis

Gla/!o%aGla/!o%a

Pr$'#a#!y 2 -&r$d#isolo#$ &r$$rr$d0Pr$'#a#!y 2 -&r$d#isolo#$ &r$$rr$d0


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recautions durin% therapyrecautions durin% therapy

/ollo


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Glucocorticoids anta%onistsGlucocorticoids anta%onists

'itotane*'itotane* structure similar to 77T, used instructure similar to 77T, used in

inoperable adrenal cancer inoperable adrenal cancer 'etyrapone*'etyrapone* inhibit 11inhibit 11 -hydroylase-hydroylase

mino%lutethamide*mino%lutethamide* inhibit conersion ofinhibit conersion ofcholesterol to pre%nolone, medical adrenelectomycholesterol to pre%nolone, medical adrenelectomy

Trilostane*Trilostane* inhibit conersion of pre%nolone toinhibit conersion of pre%nolone topro%esterone8 used in Cushin%s syndromepro%esterone8 used in Cushin%s syndrome

Detoconaole*Detoconaole* anti-fun%al, inhibit CH!0anti-fun%al, inhibit CH!0enymes, inhibit steroid synthesis in ad4corte andenymes, inhibit steroid synthesis in ad4corte and

testis8 used in Cushin%s syndrome + Ca4prostatetestis8 used in Cushin%s syndrome + Ca4prostate

'ifepristone*'ifepristone* %lucocorticoid receptor anta%onist8%lucocorticoid receptor anta%onist8anti-pro%esterone, used in Cushin%s syndromeanti-pro%esterone, used in Cushin%s syndrome


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7isease-'odifyin% ntirheumatic 7ru%s7isease-'odifyin% ntirheumatic 7ru%s

?onbiolo%ic 7'@7s

?ame Tar%et of ctiity

athioprine P/ri#$ sy#"h$sis9 i#hi7i"s T(ly%&ho!y"$ &roli$ra"io#

7-enicillamine *#+#o.#

AydroychloroEuine T(ly%&ho!y"$s>

&eflunomide Pyridi#$ sy#"h$sis

'ethotreate Dihydroola"$ r$d/!"as$9 ola"$%$"a7olis%

$ulfasalaine *#!$r"ai#9 %/l"ia!"orial=i#!l/di#' i%&air%$#" o ly%&ho!y"$/#!"io# a#d !y"o+i#$ sy#"h$sis

Biologic DMARDs

Name Target of Activity

Adalimumab TNF-α

Etanercept TNF-α

Infliximab TNF-α

Abatacept CD28

Anakinra IL-1

Rituximab CD20

Tocilizumab IL-6 receptor

IVIG* Fc receptors


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Sy#"h$"i! DMARDsSy#"h$"i! DMARDs

? M$"ho"r$;a"$M$"ho"r$;a"$

? S/l&hasala@i#$S/l&hasala@i#$

? Chloro:/i#$Chloro:/i#$? Hydro;y!hloro:/i#$Hydro;y!hloro:/i#$

? L$l/#o%id$L$l/#o%id$


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AI$T'I?AI$T'I?

++TD>I7$TD>I7$


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'ediator'ediator


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'ediator'ediator

erubahan "askular pada Inflamasierubahan "askular pada Inflamasi

M$dia"or &$r/7aha# alira# darah da#M$dia"or &$r/7aha# alira# darah da#&$r%$a7ili"as 3as+/l$r2&$r%$a7ili"as 3as+/l$r2

( 3asoa!"i3$ a%i#a -his"a%i#= s$ro"o#i#03asoa!"i3$ a%i#a -his"a%i#= s$ro"o#i#0

( 3asoa!"i3$ &$&"ida -7rady+i#i#03asoa!"i3$ &$&"ida -7rady+i#i#0( 3asoa!"i3$ li&id -&ros"a'la#di#= l$/+o"ri$#03asoa!"i3$ li&id -&ros"a'la#di#= l$/+o"ri$#0

M$dia"or +$%o"a+sis l$/+osi"M$dia"or +$%o"a+sis l$/+osi"( l$/+o"ri$# Bl$/+o"ri$# B

( Eosi#o&hil !h$%o"a!"i! a!"or o a#a&hyla;isEosi#o&hil !h$%o"a!"i! a!"or o a#a&hyla;is


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enyebab Cedera Jarin%an padaenyebab Cedera Jarin%an pada

Inflamasi dan enyakit utoimmuneInflamasi dan enyakit utoimmune

embentukanembentukan reactie oy%enreactie oy%en speciesspecies (>(>22-,-,

AA22>>22, A>Cl) and, A>Cl) and enimeenime proteolitikproteolitik

(kola%enase, elastase) oleh sel fa%osit(kola%enase, elastase) oleh sel fa%osit

Cytotoic complement proteinsCytotoic complement proteins

@espons imun seluler dan humeral@espons imun seluler dan humeral

elepasan sitokin pro-inflamasielepasan sitokin pro-inflamasi


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AI$T'I?AI$T'I?

Domponen bisa5racun seran%%a5tumbuhanDomponen bisa5racun seran%%a5tumbuhan Tersimpan di 'ast Cell + #asofilTersimpan di 'ast Cell + #asofil

(di lokasi trauma* hidun%, mulut, kaki)(di lokasi trauma* hidun%, mulut, kaki)

Terlepas pada*Terlepas pada*

14 @espons Imun14 @espons Imun

Immediate (Type I) ller%ic @eactionImmediate (Type I) ller%ic @eaction

Inflamasi akutInflamasi akut

24 @espon Dimia (%ol4 mine* morfin)24 @espon Dimia (%ol4 mine* morfin)

/D*/D* - Triple @esponseTriple @esponse* merah edema nyeri* merah edema nyeri


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/D* -/D* - Triple @esponseTriple @esponse* merah, edema, nyeri* merah, edema, nyeri

- $hock anafilaktik- $hock anafilaktik

- @an%san% uun% saraf tepi- @an%san% uun% saraf tepi nyeri, %atal A1nyeri, %atal A1

- "asodilatasi K edema arin%an- "asodilatasi K edema arin%an nadi tensinadi tensi

- #ronkokonstriksi- #ronkokonstriksi proocatif testproocatif test

- Dontraksi otot polos*- Dontraksi otot polos* A2A2

GIGI * peristalsis* peristalsis diarediare

terusterus * aborsi* aborsi

&ambun%* sekresi ACl&ambun%* sekresi ACl

- en%elolaan*- en%elolaan*

14 nta%onis /isiolo%is* epinefrin14 nta%onis /isiolo%is* epinefrin

24 nta%onis @eseptor * CT', #urimamide anti-A224 nta%onis @eseptor * CT', #urimamide anti-A2

34 @elease Inhibitor* Cromolin, ?edocromil34 @elease Inhibitor* Cromolin, ?edocromil

A1 ?TG>?I$A1 ?TG>?I$


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Gen 1* sedatif, blok reseptor otonomGen 1* sedatif, blok reseptor otonom

Gen 2* 66sedatif ( distribusi di C?$66)Gen 2* 66sedatif ( distribusi di C?$66)

- p4o4 absorbsi cepat (peak 1-2 am, durasi !-; am)- p4o4 absorbsi cepat (peak 1-2 am, durasi !-; am)

- 'etabolisme di hepar - 'etabolisme di hepar

- fek*- fek*

- sedasi- sedasi- anti-nausea5 anti-emetik- anti-nausea5 anti-emetik

- anti-arkinson (#romokriptin* anti-koliner%ik)- anti-arkinson (#romokriptin* anti-koliner%ik)

- anti-koliner%ik (tanolamine, tilendiamine)- anti-koliner%ik (tanolamine, tilendiamine)

-- LL-adrenoceptor blocker* hipotensi postural-adrenoceptor blocker* hipotensi postural

(/enotiain, rometain)(/enotiain, rometain)

- $erotonin blocker ($iproheptadin)- $erotonin blocker ($iproheptadin)

- nestesi lokal (7ifenhidramin, rometain)- nestesi lokal (7ifenhidramin, rometain)


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A1 nta%onists Generasi I s4 IIA1 nta%onists Generasi I s4 II

G$#$rasi(4 a#"a'o#is r$s$&"or H4 "ida+ s&$sii+G$#$rasi(4 a#"a'o#is r$s$&"or H4 "ida+ s&$sii+( di&h$#hydra%i#$ ) %/s!ari#i! r$!$&"orsdi&h$#hydra%i#$ ) %/s!ari#i! r$!$&"ors( Pro%$"ha@i#$ ) do&a%i#$= %/s!ari#i!=Pro%$"ha@i#$ ) do&a%i#$= %/s!ari#i!= 44

( Cy&roh$&"adi#$ ) s$ro"o#$r'i! r$!$&"orsCy&roh$&"adi#$ ) s$ro"o#$r'i! r$!$&"ors

G$#$rasi(6 a#"a'o#is r$s$&"or H42G$#$rasi(6 a#"a'o#is r$s$&"or H42( S&$sii+ &ada H4 r$!$&"orsS&$sii+ &ada H4 r$!$&"ors( Tida+ %$#$%7/s 7lood(7rai# 7arri$rTida+ %$#$%7/s 7lood(7rai# 7arri$r s$dasi +/ra#'s$dasi +/ra#'( Hal(li3$s l$7ih &a#ja#'Hal(li3$s l$7ih &a#ja#'( I#di+asi /"a%a2 all$r'i! rhi#i"isI#di+asi /"a%a2 all$r'i! rhi#i"is

( stemiole, Terfenadinestemiole, Terfenadine aritmia aritmia


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en%%unaan A1 anta%onistsen%%unaan A1 anta%onists

All$r'i! rhi#i"is ) $5'5!hlor&h$#ira%i#$= lora"idi#$ All$r'i! rhi#i"is ) $5'5!hlor&h$#ira%i#$= lora"idi#$

Mo"io# si!+#$ss ) $'5 %$!li@i#$= !hlor!y!li@i#$Mo"io# si!+#$ss ) $'5 %$!li@i#$= !hlor!y!li@i#$

Hyo"i! a'$#"s ) $5'5do;yla%i#$= di&h$#hydra%i#$Hyo"i! a'$#"s ) $5'5do;yla%i#$= di&h$#hydra%i#$

Pr/ri"is )$5'5 hydro;y@i#$Pr/ri"is )$5'5 hydro;y@i#$ S$r/% si!+#$ss( $5'5 &ro%$"ha@i#$S$r/% si!+#$ss( $5'5 &ro%$"ha@i#$

A#"i($%$"i!s( $5'5 &ro%$"ha@i#$ A#"i($%$"i!s( $5'5 &ro%$"ha@i#$

A#"i"/ssi3$ ) $5'5 di&h$#hydra%i#$ A#"i"/ssi3$ ) $5'5 di&h$#hydra%i#$ Car!i#oid "/%ors -s$ro"o#i#(%$dia"$d0 )Car!i#oid "/%ors -s$ro"o#i#(%$dia"$d0 )!y&roh$&"adi#$!y&roh$&"adi#$

All$r'i! !o#j/!"i3i"is ) $5'5 l$3o!o7as"i#$ All$r'i! !o#j/!"i3i"is ) $5'5 l$3o!o7as"i#$

7ru%s7ru%s sual dultsual dult7ose7ose

nticholinnticholiner%icer%ic

CommentsComments


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7ose7ose er%icer%icctiityctiity

/I@$T-G?@TI>? ?TIAI$T'I?$/I@$T-G?@TI>? ?TIAI$T'I?$

thanolaminesthanolamines

Carbinoamine (Clistin)Carbinoamine (Clistin) !B9 m%!B9 m% KKKKKK $li%ht to moderate sedation$li%ht to moderate sedation 7imenhydrinate (salt of7imenhydrinate (salt ofdiphenhydramine)diphenhydramine)(7ramamine)(7ramamine)

0 m%0 m% KKKKKK 'arked sedation8 anti-motion'arked sedation8 anti-motionsickness actiitysickness actiity

7iphenhydramine7iphenhydramine(#enadryl, etc)(#enadryl, etc)

2B0 m%2B0 m% KKKKKK 'arked sedation8 anti-motion'arked sedation8 anti-motionsickness actiitysickness actiity

7oylamine7oylamine 142B2 m%142B2 m% ndnd 'arked sedation8 no< aailable'arked sedation8 no< aailableonly in >TC Msleep aidsMonly in >TC Msleep aidsM

thylaminediaminesthylaminediamines

yrilamine (?eo-nter%an)yrilamine (?eo-nter%an) 2B0 m%2B0 m% KK 'oderate sedation8 component'oderate sedation8 componentof >TC Msleep aidsMof >TC Msleep aidsM

Tripelennamine (#N, etc)Tripelennamine (#N, etc) 2B0 m%2B0 m% KK 'oderate sedation'oderate sedation

iperaine deriatiesiperaine deriaties

Aydroyine (tara, etc)Aydroyine (tara, etc) 1B100 m%1B100 m% ndnd 'arked sedation'arked sedation

Cycliine ('areine)Cycliine ('areine) 2B0 m%2B0 m% B B $li%ht sedation8 anti-motion$li%ht sedation8 anti-motionsickness actiitysickness actiity

'ecliine (#onine, etc)'ecliine (#onine, etc) 2B0 m%2B0 m% B B $li%ht sedation8 anti-motion$li%ht sedation8 anti-motionsickness actiitysickness actiity

lkylamineslkylamines


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lkylamineslkylamines

#rompheniramine#rompheniramine(7imetane, etc)(7imetane, etc)

!B9 m%!B9 m% KK $li%ht sedation$li%ht sedation

Chlorpheniramine (Chlor-Chlorpheniramine (Chlor-Trimeton, etc)Trimeton, etc)

!B9 m%!B9 m% KK $li%ht sedation8 common$li%ht sedation8 commoncomponent of >TC McoldMcomponent of >TC McoldMmedicationmedication

henothiaine deriatieshenothiaine deriaties

romethaine (hener%an,romethaine (hener%an,etc)etc)

10B2 m%10B2 m% KKKKKK 'arked sedation8 antiemetic'arked sedation8 antiemetic

'iscellaneous'iscellaneous

Cyproheptadine (eriactin,Cyproheptadine (eriactin,etc)etc)

! m%! m% KK 'oderate sedation8 also has'oderate sedation8 also hasantiserotonin actiityantiserotonin actiity

$C>?7-G?@TI>? ?TIAI$T'I?$$C>?7-G?@TI>? ?TIAI$T'I?$

iperidinesiperidines

/eofenadine (lle%ra)/eofenadine (lle%ra) ;0 m%;0 m% B B &o


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en%%unaan Dlinis ntihistaminen%%unaan Dlinis ntihistamin- @eaksi ler%i* rinitis, urtikaria- @eaksi ler%i* rinitis, urtikaria

asma O (tidak efektif)asma O (tidak efektif)

- 'otion sickness- 'otion sickness

- Gen 1* difenhidramin5 dimenhidrinat, prometain- Gen 1* difenhidramin5 dimenhidrinat, prometain

sikloserin, mecliine* less sedatif sikloserin, mecliine* less sedatif

- >bat lain * skopolamin- >bat lain * skopolamin

- K efedrin5amfetamin* ==efek- K efedrin5amfetamin* ==efek

- ?ausea5"omitin% pd kehamilan- ?ausea5"omitin% pd kehamilanpiperasin * terato%enikpiperasin * terato%enik

ToksisitasToksisitas


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ToksisitasToksisitas

mirip keracunan tropinmirip keracunan tropin

eksitasi, konulsi, komaeksitasi, konulsi, koma

- stemiole, Terfenadine- stemiole, Terfenadine aritmia aritmia

pada penderita heparpada penderita hepar

interaksi d% ketokonaole, makrolidinteraksi d% ketokonaole, makrolid uice an%%ur uice an%%ur

dilaran% di $dilaran% di $


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- Cimetidine- Cimetidine

- @anitidine- @anitidine

- /amotidine- /amotidine

- ?iatidine- ?iatidine

- 'en%uran%i sekresi ACl lambun%- 'en%uran%i sekresi ACl lambun%

- 'en%hambat enim hepar - 'en%hambat enim hepar


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en%%unaan Dlinis A2 nta%onistsen%%unaan Dlinis A2 nta%onists

*l+/s Gas"ri! da# d/od$#al*l+/s Gas"ri! da# d/od$#al

R$l/; Gas"ro$soa'/sR$l/; Gas"ro$soa'/s

Esoa'i"is Erosi Esoa'i"is Erosi

H$ar"7/r#H$ar"7/r#


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Li&id A/"a!oidsLi&id A/"a!oids


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IC>$?>I7$*IC>$?>I7$*

@>$TG&?7I?$@>$TG&?7I?$

TA@>'#>F?$TA@>'#>F?$&D>T@I?$&D>T@I?$


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Farmakologi Obat Pada Reaksi Hipersensitivitas

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