analgesik fkg
TRANSCRIPT
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dr. I G A Artini, S.Keddr. I G A Artini, S.Ked
Bagian Farmakologi FK UNUDBagian Farmakologi FK UNUD
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1.1. Apa yang dimaksud dengan analgesik Apa yang dimaksud dengan analgesik antipiretik ? Sebutkan beberapa contoh antipiretik ? Sebutkan beberapa contoh obat analgesik antipiretik !obat analgesik antipiretik !
2.2. Sebutkan beberapa efek samping obat Sebutkan beberapa efek samping obat analgesik antipiretik !analgesik antipiretik !
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ANALGESIK ANTIPIRETIKANALGESIK ANTIPIRETIK
ANALGESIK ANALGESIK
NON-OPIOID (NON-NARKOTIK)NON-OPIOID (NON-NARKOTIK)ANTIPIRETIKANTIPIRETIKANTIINFLAMASIANTIINFLAMASI
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ANALGESIK NON-NARKOTIKANALGESIK NON-NARKOTIK
STRUKTUR # MORFINSTRUKTUR # MORFIN
NYERI VISERAL, TAJAM, BERAT (-)NYERI VISERAL, TAJAM, BERAT (-)
MEKANISME KERJA BERBEDAMEKANISME KERJA BERBEDA
TOLERANSI ATAU KETERGANTUNGAN TOLERANSI ATAU KETERGANTUNGAN FISIK (-)FISIK (-)
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ANALGESIK ANTIPIRETIKANALGESIK ANTIPIRETIK
1.1. NONSELECTIVE COX INHIBITORSNONSELECTIVE COX INHIBITORS(ASPIRIN, INDOMETHACINE, DIPYRONE, DICLOFENAC, MEFENAMIC ACID, PHENYLBUTAZONE, IBUPROFEN, ACETAMINOPHEN)
2.2. SELECTIVE COX-2 INHIBITORSSELECTIVE COX-2 INHIBITORS(CELECOXIB, VALDECOXIB, ROFECOXIB)
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ANTI INFLAMMATORY DRUGS
ACETAMINOPHEN & DRUGS USED IN GOUT
ANTI-INFLAMMATORY DRUGS
ACETAMINOPHENDRUGS USED IN GOUT
NSAIDs DMARDs ACUTE CHRONIC
ASPIRIN
OTHER, NON SELECTIVE NSAIDs
COX-2 SELECTIVE INHIBITORS
URICOSURICS
ALLOPURINOL
COLCHICINE, NSAIDs
GLUCOCORTICOIDS
ANALGESIK ANTIPIRETIK
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ANALGESIK ANTIPIRETIKANALGESIK ANTIPIRETIK
GOLONGAN BERD. STRUKTUR:GOLONGAN BERD. STRUKTUR:1. SALICYLIC ACID1. SALICYLIC ACID2. PYRAZOLONE2. PYRAZOLONE3. INDOL3. INDOL4. PROPIONIC ACID4. PROPIONIC ACID5. ANTHRANILIC ACID5. ANTHRANILIC ACID6. ARYLACETIC ACID6. ARYLACETIC ACID7. ANILINE7. ANILINE
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EFEK PROSTAGLANDINEFEK PROSTAGLANDIN
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EFEK SAMPINGEFEK SAMPING
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ASPIRINASPIRIN MEKANISME KERJA :MEKANISME KERJA :
menghambat COX nonselektif (ireversibel)menghambat COX nonselektif (ireversibel) FARMAKOKINETIKFARMAKOKINETIK EFEK :EFEK :
- Analgesik (nyeri ringan – sedang)- Analgesik (nyeri ringan – sedang)
- Antiinflamasi- Antiinflamasi
- Antipiretik- Antipiretik
- Antiplatelet- Antiplatelet
- ↓ sitoproteksi saluran cerna - ↓ sitoproteksi saluran cerna
- ↓ autoregulasi fungsi ginjal- ↓ autoregulasi fungsi ginjal
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ASPIRINASPIRIN
PENGGUNAAN KLINISPENGGUNAAN KLINIS
- Low range dose (< 300 mg/hr)- Low range dose (< 300 mg/hr)
- Intermediate ( 300-2400 mg/hr)- Intermediate ( 300-2400 mg/hr)
- High (2400-4000 mg/hr)- High (2400-4000 mg/hr)
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ASPIRINASPIRIN
EFEK SAMPING & TOKSISITAS :EFEK SAMPING & TOKSISITAS :
Gangguan lambung, gangguan ginjal, Gangguan lambung, gangguan ginjal, waktu perdarahan memanjang, asma, waktu perdarahan memanjang, asma, tinitus, vertigo, hiperventilasi, alkalosis tinitus, vertigo, hiperventilasi, alkalosis respiratorik, asidosis metabolik, dehidrasi, respiratorik, asidosis metabolik, dehidrasi, hipertermia, kolaps, koma, Reye’s hipertermia, kolaps, koma, Reye’s syndromesyndrome
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ASPIRINASPIRIN
KONTRAINDIKASI :KONTRAINDIKASI :
r. hipersensitivitas, perdarahan, asma, ibu r. hipersensitivitas, perdarahan, asma, ibu hamil dan menyusui, anak dengan infeksi hamil dan menyusui, anak dengan infeksi virusvirus
INTERAKSI OBAT :INTERAKSI OBAT :
activated charcoal, antacid, carbonik activated charcoal, antacid, carbonik anhidrase inhibitor, antikoagulananhidrase inhibitor, antikoagulan
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OTHER NON SELECTIVE NSAIDOTHER NON SELECTIVE NSAID INDOMETHACINE, DIPYRONE, INDOMETHACINE, DIPYRONE,
DICLOFENAC, MEFENAMIC ACID, DICLOFENAC, MEFENAMIC ACID, IBUPROFEN, PHENYLBUTAZONEIBUPROFEN, PHENYLBUTAZONE
MEKANISME KERJA : MEKANISME KERJA : menghambat COX nonselektif (reversibel)menghambat COX nonselektif (reversibel)
FARMAKOKINETIKFARMAKOKINETIK
EFEK ~ ASPIRINEFEK ~ ASPIRIN
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OTHER NON SELECTIVE NSAIDOTHER NON SELECTIVE NSAID
PENGGUNAAN KLINIS :PENGGUNAAN KLINIS :- Analgesik (nyeri ringan – sedang) - Analgesik (nyeri ringan – sedang) - Antiinflamasi- Antiinflamasi- Antipiretik- Antipiretik
EFEK SAMPING & TOKSISITAS :EFEK SAMPING & TOKSISITAS :- Gangguan saluran cerna- Gangguan saluran cerna- Gangguan ginjal- Gangguan ginjal- Anemia aplastik, agranulositosis- Anemia aplastik, agranulositosis
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OTHER NON SELECTIVE NSAIDOTHER NON SELECTIVE NSAID
KONTRAINDIKASI :KONTRAINDIKASI :
r. hipersensitivitas, ibu hamil dan menyusuir. hipersensitivitas, ibu hamil dan menyusui
Hati-hati pada gangguan perdarahan, penyakit Hati-hati pada gangguan perdarahan, penyakit ginjal, gangguan hepar dan usia lanjutginjal, gangguan hepar dan usia lanjut
INTERAKSI OBAT :INTERAKSI OBAT :
antikoagulan, litium, cyclosporin, hydantoinantikoagulan, litium, cyclosporin, hydantoin
diuretik, antihipertensidiuretik, antihipertensi
acetaminophenacetaminophen
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ACETAMINOPHENACETAMINOPHEN
PRODRUG : Phenacetin (toksik)PRODRUG : Phenacetin (toksik) MEKANISME KERJA : MEKANISME KERJA :
menghambat COX nonselektif (lemah)menghambat COX nonselektif (lemah) FARMAKOKINETIKFARMAKOKINETIK EFEK :EFEK :
- Analgesik - Analgesik - Antipiretik - Antipiretik - Antiinflamasi (-) atau lemah- Antiinflamasi (-) atau lemah- Antiplatelet lemah- Antiplatelet lemah
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ACETAMINOPHENACETAMINOPHEN
PENGGUNAAN KLINIS :PENGGUNAAN KLINIS :
- Analgesik - Analgesik
- Antipiretik- Antipiretik
→ → pengganti aspirinpengganti aspirin
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ACETAMINOPHENACETAMINOPHEN
EFEK SAMPING & TOKSISITAS:EFEK SAMPING & TOKSISITAS:
Hepatotoksik, gangguan hematologi, Hepatotoksik, gangguan hematologi, nekrosis tubulus ginjal, hipoglikemia, nekrosis tubulus ginjal, hipoglikemia, kelainan kulitkelainan kulit
Toksisitas akut : 10-15 gram (alkoholik)Toksisitas akut : 10-15 gram (alkoholik)
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ACETAMINOPHENACETAMINOPHEN
KONTRAINDIKASI :KONTRAINDIKASI :
r,hipersensitivitas, alkoholikr,hipersensitivitas, alkoholik
Paling aman untuk ibu hamil dan Paling aman untuk ibu hamil dan menyusuimenyusui
INTERAKSI OBAT :INTERAKSI OBAT :
alkohol, isoniazid, rifampin, barbiturat, alkohol, isoniazid, rifampin, barbiturat, hydantoin, loop diuretikhydantoin, loop diuretik
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COX-2 SELECTIVE INHIBITORCOX-2 SELECTIVE INHIBITOR
Celecoxib, Rofecoxib, ValdecoxibCelecoxib, Rofecoxib, ValdecoxibPerbedaan dgn. nonselective COXIB :Perbedaan dgn. nonselective COXIB :
- Efek gastrointestinal <- Efek gastrointestinal <
- Antiplatelet (-)- Antiplatelet (-)
- Kardioprotektif (-)- Kardioprotektif (-)
- Tdk direkomendasikan pd disfungsi ginjal- Tdk direkomendasikan pd disfungsi ginjal
- Risiko stroke, infark miokard - Risiko stroke, infark miokard KI : hipersensitif thd. SulfonamideKI : hipersensitif thd. Sulfonamide
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