Obat Respiratory PSIK
-
Upload
devi-ayunda -
Category
Documents
-
view
142 -
download
2
Transcript of Obat Respiratory PSIK
FARMAKOLOGI OBAT SISTEM RESPIRATORORIUS
Setyawati SKFarmakologi FKUB
3
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)
4
• Obat-obat yang bekerja pada sistem respiratorius • Antihistamin• Nasal dekongestan • Obat batuk & mukolitik• Bronkhodilator• Kortikosteroid• Kromoglikat• Antagonis Leukotrien
Saluran nafas atasSimptomatik
Saluran nafas bawah
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
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 patient’s 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 : Early response :Inflamation Bronchoconstriction
Hyperreactivity Symptom
Ag (polutan, alergen) hindari
Ag-Ab/IgE di mast cell kromolin, steroid
MEDIATORsteroid agonis , teofilin, anti kholinergikLate response : Early response :Inflamation Bronchoconstriction
Hyperreactivity Symptom
TERAPI
TERAPI1. BRONKHODILATOR
2. ANTIINFLAMASI
3. LAIN-LAIN * mukolitik* antitusif, ekspektoran ?
* antihistamin* antibiotik jk.perlu* preventif kromolin
steroidCATATAN :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- FormoterolSelektivitas 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 AlertsWhen 2 or more puffs are needed, inform the patient that at least 1 minute should be allowed between puffsInform the patient that salmeterol and formoterol, and oral β-2 agonists should be taken on a fixed schedule, not on a prn basisInstruct the patient to report chest pain and changes in heart rhythm or rate, because β-2 agonists can cause cardiac stimulationContact 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 µg/ml. Dosage should be adjusted to keep theophylline levels below 20 µg/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, takikardiEfektif 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 p.o mild asma : inhaler
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