8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
1/36
1J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
2/36
Ototoksik
Mhs dapat mengetahui adalah obat-obat/gol obat yang dapat menyebabkan
gangguan pada fungsipendengaran/alat pendengar
Mhs dapat membedakan obat-obat/gol
obat yang menyebabkan ototosik
2J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
3/36
It's Up To You
If you are like most people, you never give drugs asecond thought. Your doctor prescribes themyoutake them. It never enters your head that thesedrugs may be damaging your ears.
Manyhealth care professionals know little ornothing about ototoxic drugs and theirpronounced effects on hard-of-hearing people.Therefore, it is up to you to do all you can toprotect your ears from the ravages of ototoxicdrugs and chemicals.
3J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
4/36
Ototoxic DrugsWhat Are They?
Ototoxic (OH-toe-TOKS-ik) drugs are thosemedications that can cause ototoxic (eardamaging) side effects to your ears.
Such drugs can cause hearing loss, hyperacusis(normal sounds now too loud), tinnitus and otherphantom sounds, and a whole host of balance
problems. This does not happen to everyone whotakes drugs by any means, but it does happen to asignificant number ofunfortunatepeople.
4J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
5/36
Sudden Hearing Loss
Sudden Hearing Loss is a Medical Emergency:Recently I woke up and discovered I had lost the
hearing in my left ear while I slept. I went to mylocal doctor, but he didn't seem to think it was abig deal. He told me it was likely my ear pluggedup from a cold and to come back in a few days if itdidn't get better. I'm scared. Ten days have gone by,and I still can't hear out of my ear. What should Ido?
5J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
6/36
Ketulian / Gangguan pendengaran
salah satu cacat tubuh yg banyak dijumpai
Insiden
Di Negara berkembang : 10% (dari jlh penduduk)
Survey DepKes di Jatim (1996) :
ganggauan pendengaran 16,8% ketulian 0,4%
Di Poli Audiologi : 29,38% (dari jlh kunjungan per tahun)
Penyebab a.l. : cacat bawaan, otitis media,
presbikusis, tuli mendadak, kecelakaan
atau trauma bising. (Palandeng.O.I)
6J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
7/36J.A.Najoan.dr.MKes.SpFK. 7
Berkurangnya Pendengaran & Tuli DEFINISI
Berkurangnya Pendengaran adalah penurunan fungsipendengaran pada salah satu ataupun kedua telinga.Tuli adalah penurunan fungsi pendengaran yang sangatberat.
PENYEBABPenurunan fungsi pendengaran bisa disebabkan oleh: Suatumasalah mekanis di dalam saluran telinga atau di dalamtelinga tengah yang menghalangi penghantaran suara
(penurunan fungsi pendengaran konduktif) Kerusakan padatelinga dalam, saraf pendengaran atau jalur sarafpendengaran di otak (penurunan fungsi pendengaransensorineural).
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
8/36J.A.Najoan.dr.MKes.SpFK. 8
Penurunan fungsi pendengaran sensorineuraldikelompokkan lagi menjadi:- Penurunan fungsi pendengaran sensorik (jika
kelainannya terletak pada telinga dalam)- Penurunan fungsi pendengaran neural (jika kelainannya
terletak pada saraf pendengaran atau jalur saraf
pendengaran di otak).
Penurunan fungsi pendengaran sensorik bisa merupakanpenyakit keturunan, tetapi mungkin juga disebabkan oleh:
- Trauma akustik(suara yang sangat keras)- Infeksi virus pada telinga dalam- Obat-obatan tertentu- PenyakitMeniere.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
9/36
KETULIAN AKIBAT BAHAN OTOTOKSIKA. Luar ( eksogen)
Obat obatanB. Dalam (endogen)
D.M
Penyakit Ginjal (Palandeng.O.I)
9J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
10/36
Materi yang akan dibahas :
Ketulian akibat bahan ototoksik
10J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
11/36
GAMBARAN KLINIK Ototoksik -- gangguan pendengaran. Tergantung:
dosis, waktu paruh obat, fungsi ginjal atau kondisidari stria vaskularis.
Keluhan : Tinitus, pendengaran menurun bilateral,vertigo (sering disertai muntah), gangguan
keseimbangan, oksilopsia.
11J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
12/36
Kerusakan Telinga Akibat Obat-obatan
Beberapa obat, seperti:
- antibiotik tertentu
- diuretik (terutama asam etakrinat dan furosemid)- Aspirin dan zat-zat yang menyerupai Aspirin (salisilat)- kuinin bisa menyebabkan kerusakan pada telinga.
- Obat-obat tertentu menyebabkan gangguan pendengarandan keseimbangan, tetapi sebagian besar obat lebihbanyak menyebabkan gangguan pendengaran.
12J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
13/36
Hampir seluruh obat tersebut dibuang dari tubuhmelalui ginjal.
Karena itu setiap kelainan fungsi ginjal akanmeningkatkan kemungkinanpenimbunan obatdi dalam darah dan mencapai kadar yang bisa
menyebabkan kerusakan.
13J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
14/36
Dari semua jenis antibiotik, neomisinmemiliki efek yang paling berbahayaterhadap pendengaran, diikuti oleh
kanamisin dan amikasin.Viomisin, gentamisin dan tobramisin bisamempengaruhi pendengaran dankeseimbangan.
14J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
15/36
Antibiotik streptomisin lebih banyakmempengaruhi keseimbangan.
Vertigo (perasaan berputar) dan gangguankeseimbangan akibat streptomisin cenderungbersifat sementara. Tetapi kadang bisa terjadisindroma Dandy, dimana gangguan keseimbanganbersifat menetap dan berat sehingga penderitamengalami kesulitan jika berjalan dalam ruangan
yang gelap.
Jika diberikan suntikan asam etakrinat dan
furosemid kepada penderita gagal ginjal yang jugamenjalani pengobatan dengan antibiotik, akanterjadi tuli permanen atau tuli sementara.
15J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
16/36
Aspirin dalam dosis yang sangat tinggi yangdigunakan dalam jangka panjang bisamenyebabkan tuli dan tinnitus (telingaberdenging), yang biasanya bersifatsementara.
Kuinin bisa menyebabkan tuli permanen.
Jika terjadiperforasi gendang telinga, obat-obat yang bisa menyebabkan kerusakan
telinga tidak dioleskan/diteteskan langsungke dalam telinga karena bisa diserap kedalam cairan di telinga dalam.
16J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
17/36
Antibiotik yang bisa menyebabkan gangguanpendengaran tidak diberikan kepada:- wanita hamil- usia lanjut- orang yang sebelumnya telah menderita ketulian.
Kepekaan setiap orang terhadap obat-obattersebut bervarisi, tetapi biasanya ketulian bisadihindari jika kadar obat dalam darah beradadalam kisaran yang dianjurkan.
Karena itu biasanya dilakukan pemantauanterhadap kadar obat dalam darah. Jikamemungkinkan, sebelum dan selama menjalanipengobatan dilakukan tes pendengaran.
17J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
18/36
Biasanya tanda awal dari kerusakanadalah ketidakmampuan untukmendengarkan suara dengan nada
tinggi.Bisa terjadi tinnitus (telingaberdenging) atau vertigo.
18J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
19/36
For example, one man who had taken Diazepamfor 8 years for anxiety, got obnoxious tinnitus just 4
days after discontinuing Diazepam. His tinnituspersisted for 3 months. Fortunately, after 6months, his tinnitus was only occasional and ofshort duration, and by 1 year it had completelydisappeared.
Another man began to hear high-pitched ringingtinnitus in both his ears for the first time in his lifeas he reduced his Diazepam dose to a low level.Unfortunately, in his case, he still had tinnitus 1
year later but was learning to cope with it.
19J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
20/36
For example, Joan takes Celecoxib for herarthritis. When she takes it, her tinnitus gets
louder, but her arthritis pain improves. Shechooses the increased tinnitus (which doesntreally bother her) over the arthritis pain (whichshe definitely doesnt like). That is her choice, andshe is content to live with it.
Harold, on the other hand, began takingAmitriptyline and soon noticed he had severetinnitus. His tinnitus was driving him buggy sohe contacted me for help. I suggested the
Amitriptyline might be causing his tinnitus. Withhis doctors permission, he stopped taking thedrug. Twelve days later, he joyfully reported thathis tinnitus went away. That was his choice and heis glad he made it.
20J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
21/36
Drug Interactions and EarsLittle is known about how ototoxic drugs adverselyaffect our ears. Dramatically less is known about
ototoxic side effectswhen two or more ototoxic drugsare consumed at the same time. However, someinteresting (and important) things have come to lightin recent years.
21J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
22/36
The Order of Multiple Ototoxic Drugs Can BeImportant
Researchers have discovered that the order a person takes certainototoxic drugs can make an enormous difference as to whether theyhave much of a resulting hearing loss or not. With some drugcombinations, if you take the drugs sequentially, and notsimultaneously, you can avoid the synergistic effect.
For example, in one medical treatment, doctors put their patients ontwo drugs, a LOOP DIURETIC (e.g., Furosemide) and an
AMINOGLYCOSIDE antibiotic (e.g., Tobramycin). If the patientcompletes the course of the LOOP DIURETIC before he begins the
AMINOGLYCOSIDE antibiotic, the resulting hearing loss from thesetwo drugs is additive. However, if the patient takes both drugs
simultaneously or if the AMINOGLYCOSIDE antibiotic is administeredfirst, followed by the LOOP DIURETICthe two drugs actsynergistically to significantly damage the patient's ears.
22J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
23/36
Some of the drugs that have this viciouseffect includeAspirin, the anti-cancerdrug Cisplatin, the microbial
antibiotic Chloramphenicol andAMINOGLYCOSIDE antibiotics suchas Gentamicin and Kanamycin.
23J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
24/36
This same synergistic effect on hearing loss
between the ototoxic side effects of certain drugsand noise also occurs between certain chemicalsand noise.
Chemicals that make our ears more prone tohearing loss as a result of noise include organicsolvents such as carbon disulfide,
dinitrobenzene, styrene, trichloroethylene,toluene and xylene as well as the asphyxiantcarbon monoxide and the heavy metal lead.
24J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
25/36
Other chemicalswith this same
nefarious characteristic includearsenic, butyl alcohol, butyl nitrite,heptane, hexane, manganese,
mercuryand trimethyltin. Thisapparently is just the tip of the iceberg.Suspicion is already cast on carbon
tetrachloride, various other metalsand asphyxiants.
25J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
26/36
There are a number oforganic solvents.Some of them are benzene, benzylalcohol, butylalcohol, carbondisulfide,carbon tetrachloride, heptane, hexane,styrene, toluene, trichloroethylene andxylene. Ototoxic heavy metals includearsenic, cobalt, lead, manganese,
mercuryand trimethyltin.
J.A.Najoan.dr.MKes.SpFK. 26
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
27/36
Learn the secrets of ototoxic drugs now.
You will be well-equipped to protectyourself from ear-damaging (ototoxic)drugs once you know the following:
Exactly what ototoxic drugs are.
24 symptoms of damage ototoxic drugs cando to your ears apart from hearing loss andhow this damage can adversely affect thequality of your life for years to come.
1
27J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
28/36
19 drugs that have a severe risk of damaging yourears (and 96 that have a moderate risk). Ask your
doctor to substitute lower-risk drugs if at allpossible.
Details on 743 drugs, 30 herbs and 148 chemicals
that can damage your ears.
Find whatever drug you are looking for fast
whether you know the brand name or the genericname. 2,055 drug brand and generic names listed.
2
28J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
29/36
Aminoglikosid
Efek AntimikrobaAminoglikosid ..gol antibiotika, bakterisidal ntoksikterhadap saraf otak VIII komponen vestibuler maupunakustik (ototoksik) dan terhadap ginjal (nefrotoksik)
Aktivitas dan mekanisme kerja- pada gram- negatif yang aerob (gentamisin,
tobramisin, kanamisin, netilmisin dan amikasin)
- aminoglikosid terikat riboson 30S dan menhambat
sintesis protein- neomisin, farmisetin dan paromomisin tidak
dianjurkan untuk sistemik
29J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
30/36
Efak samping aminoglokosid1. Alergi
- Rash, eosinofilia, demam, diskrasiadarah, angioudema, dematitiseksfoliatif, stomatis dan syok
anafilaktik
30J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
31/36
2. Reaksi iritasi dan toksikEfek toksik aminiglikosid pada sarafotak N.VIII mengenai komponen
vestibular dan akustik.
- Streptomisin dan gentamisin lebihmempengaruhivestbular
- Neomisin, kanamisin, amikasin dandihidrostreptomisin lebihmempengaruhi akuatik
J.A.Najoan.dr.MKes.SpFK. 31
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
32/36
Oksitoksisitas aminoglikosid
dipengaruhi beberapa faktor :- besarnya dosis
- adanya gangguan faal ginjal
- usia tua- penggunaan oksitoksik lainya
- pemberian bersama asa etakrinat (diureti kuat)
- terapi berkepanjangan- demam
J.A.Najoan.dr.MKes.SpFK. 32
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
33/36
Gangguan vestibular Gejala dini ialah sakit kepala, pusing, mual, muntah
dan gangguan keseimbangan
Tidak ada terapi khusus
Pemulihan dengan waktu 12 18 bulan pada beberappasien bisa menetap
Kerusakan pada nukleus kohliaris ventral dibtg otak
meluas ke ujung saraf di kohlea
J.A.Najoan.dr.MKes.SpFK. 33
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
34/36
Gangguan akustik Tidak selalu pada kedua telinga
Gangguan gel frekwnsi tinggi berkurang
Secara klinis sebagai tuli saraf Tinitus bernada tinggi samapi 2 minggu aminiglikosid
dihentikan
Kerusakan akustik terutama berupa degenerasi berat
sel rambut organ Corti dari basilaris sampai apeksJarang terjadi pada anak
J.A.Najoan.dr.MKes.SpFK. 34
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
35/36
Pengobatan
Belum ada yang pasti
Obat kurang bermanfaatSebagian besar sembuh spontan
- Kortikosteroid- Vasodilator
35J.A.Najoan.dr.MKes.SpFK.
8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga
36/36
PENATALAKSANAAN
Obat ototosik dihentikan
Pemberian Dekstran intravenous
Kortikosteroid
Top Related