Pertemuan 9. Antihiperlipidemik

8/17/2019 Pertemuan 9. Antihiperlipidemik

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HIPERLIPIDEMIA

KHILDAH KHAERATI, S.Si, M.Si,Apt

JURUSAN FARMASIUNIVERSITAS TADULAKO


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HIPERLIPIDEMIA

Kelainan metabolime lipi! !itan!ai!en"an #elainan penin"#atan ata$pen$%$nan &%a#i lipi! !alam plama.

F%a#i lipi! $tama ' Kadar kolesteroltotal yang tinggi, kadar trigliserida

yang tinggi, dan kadar kolesterol

HDL yang rendah.(iaan)a !i*$b$n"#an !"n %ii#o

te%+a!in)a ate%o#le%oi ata$ PJK


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Kolete%ol LDL e&e# ate%o"eni# pembent$#anat*e%oma-!epoit lema# p! lapian !alam a%te%i-!i !in!in" a%te%i te%!apat p! ate%o#le%oi. (iame%$a# ali%an !a%a*.

Kolete%ol HDL e&e# p%ote#ti& melin!$n"i +ant$n"- #a%ena be%pe%an !alam %ee%e/*olete%ol t%anpo%t )ait$ men"an"#$t #olete%ol!a%i +a%in"an pe%i&e% #e *ati $nt$# #em$!ian

!i#ataboliai#an !an !ie##%ei#an melal$iempe!$. A!a #o%elai ne"ati& anta%a #a!a%#olete%ol HDL !en"an PJK.

T%i"lie%i!a t!# be%e&e# ate%o"eni#, nam$n

men+a!i &a#to% %ii#o PJK bila !iba%en"i !"nen$%$nan #a!a% HDL

HIPERLIPIDEMIA


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LIPOPROTEIN

Lipop%otein me%$pa#an en)a0a#omple# )an" te%$$n !a%i mole#$llipi! #olete%ol, t%i"lie%i!a,

&o&olipi!- !an mole#$l p%oteinapop%otein- membent$# mole#$llipop%otein ini te%+a!i !alam epitel

$$ *al$ el m$#oa-.


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JENIS LIPOPROTEIN

Kilomi#%on lipop%otein )an" palin" bea%,!ibent$# !i $$ !an memba0a t%i"lie%i!a)an" be%aal !a%i ma#anan.

Kilomi#%on %emnan a!ala* #ilomi#%on )an"tela* !i*ilan"#an eba"ian t%i"lie%i!n)ae*in""a $#$%ann)a men"e/il tetapi +$mla*ete% #olete%oln)a tetap.

Ve%) lo0 !enit) lipop%otein VLDL-

Inte%me!iate !enit) lipop%otein IDL-Lo0 !enit) lipop%otein LDL-

Hi"* !enit) lipop%otein HDL-


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Klasifkasi Hiperlipidemiaklasifkasi Fredrickson)

• Tipe I *ipe%lipop%oteinemia a!ala* bent$#*ipe%lipop%oteinemia te%#ait !en"an !e1ieni

lipop%otein lipae.• Hipe%#ilomi#%onemia mai& pa!a 0a#t$ p$aa0ala$p$n +$mla* lema# !alam #ea!aan no%mal.Men)ebab#an penin"#atan t%iail"lie%ol e%$m )an"an"at tin""i

Hiperlipoproteinemi

a tipe I(Hiperkilomkronemia

Familial)

• H)pe%lipop%oteinemia tipe II, e+a$* ini me%$pa#anbent$# palin" $m$m, a!ala* lebi* !i#lai1#ai#an

men+a!i tipe IIa !an IIb +eni, te%"ant$n" te%$tamapa!a apa#a* a!a eleai !i tin"#at t%i"lie%i!a elain#olete%ol LDL.

Hiperlipoproteinemi

a tipe II

• (Hiperkolesterolemia Familial) Penin"#atan LDL!en"an #a!a% VLDL no%mal #a%ena pen"*ambatan!alam !e"%a!ai LDL, e*in""a te%!apatpenin"#atan #olete%ol e%$m tapi t%iail"lie%ol

no%mal.

Tipe

IIa

• (Hiper lipidemia Kombinasi Familial) Tin"#atVLDL tin""i #a%ena #elebi*an p%o!$#i $bt%at,te%ma$# t%i"lie%i!a, aetil KoA, !an penin"#atan!alam (2344 intei. Me%e#a +$"a !apat!iebab#an ole* pembe%i*an pen$%$nan LDL.

TipeIIb


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• T%i"lie%i!a tin""i. Hal ini +$"a !i#enal eba"aihipertrigliseridemia m$%ni *ipe%t%i"lie%i!emia-.

Men$%$t N5EP2ATPIII !e1nii t%i"lie%i!a tin""i 6744 m" 8 !l-,

Hiperlipoproteinemia tipe IV

(Hipertrigliseridemia Familial)

• Jeni ini an"at mi%ip !en"an tipe I, tetapi !en"anVLDL )an" tin""i !i ampin" #ilomi#%on. Ka!a%#olete%ol !an t%iail"lie%ol menin"#at.

Hyperlipoproteinemia tipe V

(Hipertrigliseride

mia CampuranFamilial)

• Kilomi#%on tin""i !an IDL inte%me!iate !enit)lipop%otein-. J$"a !i#enal eba"ai pen)a#it ata$beta )an" l$a !)betalipop%oteinemia- pen)ebabpalin" $m$m $nt$# &o%m$li% ini a!ala* a!an)a"enotipe apoE E78E7. Hal ini #a%ena #olete%ol VLDL)an" #a)a 92VLDL-.

Hiperlipoproteinemia tipe III

(Disbetalipoproteinemia Familial)


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H$b$n"an #a!a% lipi! !en"an %ii#oPJK

lipid Diinginkanmg/d

Di!aspadaimg/d

"erbahayamg/d

Kolete%ol total : 744 74427;< 67=4

Kolete%ol LDL

Tanpa PJK D"n PJK

: 3;4: 344

3;423><2

63?42

Kolete%ol HDL ;>2=> :;>

T%i"lie%i!atanpa PJK

!"n PJK :744:3>4

7442;


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#$%IHI&'I&ID'I#*

#ntihiperlipidemia adalahobat yang digunakan untuk

menurunkan kadar lipidplasma Fa%ma#olo"i !an Te%apie! V. 744-.


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TUJUAN PENCO(ATAN

Men$%$n#an p%o!$#ilipop%otein !alam +a%in"an

Menin"#at#an #atabolimelipop%otein !alam plama

Mempe%/epat be%i*an#olete%ol !a%i t$b$*


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Te%api Hipe%lipi!emia

3. Te%api Non2&a%ma#olo"i ' Diet

7. Te%api &a%ma#olo"i !"n obat2obat *ipolipi!emi# bila!iet "a"al men$%$n#an #a!a% lema# !a%a*.

a. Obat )" men$%$n#an #a!a% #olete%ol

2 %ein pen"i#at aam empe!$ ' #oletipol, #oleti%amin

2 pen"*ambat enim HMC 5o2A %e!$#tae tatin- '

imatatin, p%aatatin, loatatin, $atatin2 aam ni#otinat ata$ niain, !e%iat aam ni#otinatinoitol *eani/otinate-, analo" aam ni#otinat a/ipimo-

2 D2ti%o#in2 P%ob$#ol

b. Obat )" men$%$n#an #a!a% t%i"lie%i!a

2 "olon"an aam 1b%at8#lo1b%at

2 aam ni#otinat 33


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#, $I#-I$ ( #-#$IK.%I$#% )

• Niain a!ala* $at$ pen"*ambat #$atpa!a item lipae int%ael$le% !a%i

aringan adiposa, )an" !i!$"a !apat

men$%$n#an p%o!$#i VD Very LowDensity Lipoprotein- !en"an men$%$n#anali%an aam lema# beba #e *ati.

• Me%$pa#an itamin la%$t ai% )" mamp$men$%$n#an #a!a% t%i"lie%i!a !an#olete%ol plama


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Me#anime Ke%+a '

T%iail"lie%ol

Aam Lema#

Aam Lema#

T%iail"lie%ol

VLDL

0aringan

#diposa

Hati

$I#-I$


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DOSISDoi ;2? "8*% !alam pen"obatan

t$n""al !apat men$%$n#an #a!a%

#olete%ol LDL 3>2=4G !anmenai##an #a!a% HDL 3>274G.

Pen"obatan #ombinai !"n %ein,

!apat men$%$n#an #a!a%#olete%ol LDL =42?4G.


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NIASIN ASAM NIKOTINAT -

&enggunaan dalam terapi 1

3. Me%en!a*#an #a!a% plama#olete%ol !an

t%iail"lie%ol

7. Hipe%lipop%oteinemia tipe IIb !anIV

;. Hipe%#olete%olemia.

=. Hipe%lipi!emia palin" poten $nt$#

menin"#at#an #a!a% HDL plama


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'2ek -amping1

3. Keme%a*an pa!a #$lit

!ie%tai %aa pana )an" ti!a# n)aman -

7. P%$%it$

;. M$al !an a#it pa!a ab!omen

=. Hipe%$%iemia

>. Pi%ai "o$t-?. Pen$%$nan tole%ani "l$#oa pa!a te%api +an"#a pan+an" !an *epatoto#iita.


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Contoh dipasaran 1

3. Aam Ni#otinat Ni/ona/i! -

7. Pi%i!ilmetanol Ra!e/ol -;. Aipimo# Olbemo -


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(. FIL(RAT KLOFI(RAT DANCEMFI(ROIL

• Me%$pa#an Deri3at #sam fbrat,

• Memp$n)ai me#anime #e%+a )an"ama.


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Me#anime Ke%+a '

Empat me#anime #$n/i obat "olon"an1b%at'

3. Menin"#at#an lipolisis

7. Menin"#at#an asupan asam lemakhati !an men$%$n#an produksitrigliserida hati

;. Menin"#at#an asupan D ole*

%eepto% LDL=. Mentim$lai transport kolesterol

balik e*in""a menin"#at#an HDL


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FIL(RAT KLOFI(RAT DANCEMFI(ROIL


3. Pen"obatan Hipe%"lie%i!emia

7. Pen"obatan Hipe%lipi!emia %ipe III;. Pen"obatan Hipe%t%i"lie%i!emia


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'2ek samping 1

3. E&e# Cat%ointetinal ' Can""$anpen/e%naan %in"an

7. Litiai ' Pembent$#an bat$ empe!$

;. Ke"anaan ' Kematian

=. Otot ' Mioiti pe%a!an"an otot polo -

>. Inte%a#i obat ' Menin"#at#an e&e#anti#o"$lan epinta


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Contoh dipasaran 1

3. Cem1b%oil Ceilon -

7. Klo1b%at 5lo1b%at STADA >44 -;. (ea1b%at 5e!$% -

=. Eto1b%at LipoMe% -

>. Feno1b%at No%malip -


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C, '-I$ &'$4IK#% #-# '&'D5 ( K.'-%I#I$ D#$ K.'-%I&. )

• Obat )an" be#e%+a pa!a al$%anpen/e%naan

• (e#e%+a !en"an /a%a men"i#at aam

empe!$ !i $$ !an menin"#at#anpemb$an"an LDL !a%i ali%an !a%a*

• Koletipol !an Koleti%amin *an)a

be%man&aat pa!a *ipe%lipop%oteinemia)an" melibat#an penin"#at#an LDLa+a.


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Me#anime Ke%+a

a1nita tin""ite%*a!ap aam

empe!$.

Aam empe!$a#an !ii#at ole*

%ein

membent$#en)a0a )an"ti!a# la%$t !an

ta# !apat!i%eabo%bi

!ie##%eimelal$i &ee

Aam empe!$men$%$n

Sintei AamEmpe!$ !a%i#olete%ol !i

LDL

#a!a% LDLplama

men$%$n.


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RESIN PENCIKAT ASAM EMPEDU KOLESTIRAMIN DAN KOLESTIPOL -


3. Anti *ipe%lipi!emia tipe IIa !an IIb

7. Me%in"an#an p%$%it$ a#ibata#$m$lai aam empe!$ pa!apaien !en"an obt%$#i bilie%.


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'2ek -amping 1

3. E&e# "at%ointetinal ' "an""$an pen/e%naanepe%ti #ontipai, m$al !an at$

7. Can""$an abo%bi ' te%"an""$n)a abo%biitamin la%$t lema# A,D,E,K #a%ena !oi %ein)an" tin""i, be%#$%an"n)a abo%bi aam &olat!an aam a#o%bat

;. inte%a#i obat ' Koleti%amin !an Koletipol

men""an""$ abo%bi bebe%apa obat !alam $$,mialn)a tet%ai#lin,&enoba%bital,!i"oin,0a%&a%in,p%aatatin,$atatin,api%in !an !i$%eti# tiai!.


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Contoh di pasaran1

3. Koleti%amin$antalan-

7. Koletipol5oleti! C%an$lat-;. Sitote%ol Sito2Lan!e-


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D, &."5K.

• Obat antilipi!emia )an" memili#ii&at antio#i!an !alam men"*ambatate%o#le%oi.

• Obat ini ti!a# !i$#ai #a%ena +$t%$men$%$n#an #a!a% HDL lebi* bea%!a%ipa!a LDL.


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Me#anime #e%+a'

LDL

oLDL

SEL (USA

DI ENDOTEL VASKULAR

ATEROSKLEROSIS

&."5K.6 #$%I.K-ID#$ #I$

-5&'.K-ID#$I%#% .K-ID#H7

.7

#K.F#4


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PRO(UKOL

&enggunaan dalam terapi1

3. Anti*ipe%#olete%olemia tipe IIA !anII(

7. Dibe%i#an aat anti*ipe%lipi!emia lainti!a# e&e#ti&.

&robukol tidak mengganggu kadartriasilgliserol dalam plasma,


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'2ek samping1

3. Can""$an pen/e%naan %in"an

7. Mempe%pan+an" inte%al T

Contoh di pasaran1

P%ob$/ol Lorelco-


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', I$HI"I%. H48Co#'D5K%#-'

• Anti*ipe%lipi!emia ba%$ )an"men"*ambat ta*ap pe%tamaa#tiita enim !alam intei

#olete%ol.


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Me#anime #e%+a'

3. In*ibii HMC25oA %e!$#tae

A1nita !en"an enim #$at e*in""ae&e#ti& !alam men"*ambat HMC25oA%e!$#tae e*in""a HMC25oA ti!a#

ampai men+a!i aam mealonat!alam ta*apan intei #olete%ol.

Pen"*ambatan ini a#an men)ebab#anpengurangan simpanan kolesterolintraseluler,


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7. Penin"#atan %eepto% LDL

Te%+a!i #enai#an HDL !an pen$%$nan t%iail"lie%ol

Pen"*ap$an #olete%ol int%ael$le%

Sel menin"#at#an '-'&%. D

Pen$%$nan #olete%ol plama !anpenin"#atan #atabolime LDL


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INHI(ITOR HMC25oAREDUKTASE

&enggunaan terapi1

Men$%$n#an #a!a% #olete%ol plamapa!a em$a +eni *ipe%lipi!emia


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'2ek samping1

3. Kelainan bio#imia &$n"i *ati

7. miopati !an %*ab!omiolii

;. Menin"#at#an #onent%ai t%anaminae=. Kel$*an ab!ominal %in"an

>. R$am #$lit

?. Ran"an"an "atal

. N)e%i #epala

@. Lela*


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Contoh di pasaran1

3. Loatatin Meina/o%-

7. P%aatatin P%aain, Lip%eil-

;. Simatatin Denan, o/o%-

=. Fl$atatin 5%ano/, LO5OL-

>. Ato%atatin So%ti-?. 5e%iatatin LIPO(A, ena-


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%erapi .bat Kombinasi

• Pembe%ian !$a anti*ipe%lipi!emia$nt$# men!apat#an pen$%$nan#a!a% lipi! plama )an" i"ni1#an.

• 5onto*' – Kombinai niasin !en"an pen"i#at

aam empe!$, kolestiramin pa!a

*ipe%lipi!emia tipe II, – Kombinai in*ibito% HMC25oA %e!$#tae

!en"an pen"i#at aam empe!$men$n+$##an man&aat !alam

# # l t l LDL

Pertemuan 9. Antihiperlipidemik

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