kp 3_farmakologi sistem endokrin
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farmako endokrinTRANSCRIPT
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SISTEM ENDOKRIN
Sistem endokrin diatur oleh hipotalamus dan kelenjar hipofisis, mengkoordinasi fungsi-fungsi tubuh dengan melepaskan hormon ke dalam aliran darah, memancarkan pesan antar sel dan jaringan
Hormon substansi kimia yang bekerja pada berbagai jaringan dan organ yang mempengaruhi aktivitas seluler
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Kelenjar Hormon
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Hormon Adrenokortikotropik (ACTH) Hipofisis anterior dipacu untuk menghasilkan
ACTH oleh CRH (Corticotropic Releasing Hormone)
Merangsang pelepasan :
1. Kortisol (glukokortikoid)respon stres(oleh adrenal)
2. Mineralokortikoid (aldosteron)=(mempengaruhi tekanan darah dan kadar garam)
3. Androgen(hrmn sekstrdpat pada testis) Peningkatan serum kortisol dari korteks adrenal
akan menghambat pelepasan ACTH di hipofisis
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Hormon Pertumbuhan (Growth Hormone)
Somatotropin Hormon (STH) Bekerja pada semua jaringan tubuh
terutama pada tulang dan otot rangka (otot skelet)
Jumlah diatur oleh growth hormone releasing hormone (GHRH) dan growth hormone inhibiting hormone (GHIH)
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Gonadotropin Releasing Hormone (GnRH)
Mengatur sekresi hormon dari testis dan ovarium, yaitu :1. Folicle Stimulating Hormone (FSH) mempercepat pematangan folikel ovarium dan mengaktifkan produksi sperma di testis2. Luteinizing Hormone (LH) bergabung dengan FSH bekerja dalam pematangan dan produksi estrogen dan mempercepat sekresi androgen dari testis3. Prolactin merangsang pembentukan air susu dalam jaringan payudara sesudah melahirkan
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Hormon Hipofisis Posterior ADH (Antidiuretic Hormone)
meningkatkan penyerapan kembali air dari tubulus ginjal, dan mengembalikannya ke sirkulasi sistemik
Oksitosin merangsang kontraksi dari otot polos pada uterus
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Hormon Paratiroid
Kelenjar paratiroid mensekresi 2 pasang hormon :1. Parathormon atau hormon paratiroid (PTH)
Mengatur kadar kalsium dalam darah2. Kalsitonin
Menghambat reabsorbsi kalsium oleh tulang dan meningkatkan ekskresi kalsium dari ginjal. Kalsitonin menghambat kerja PTH
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Hormon Tiroid Fungsi tiroid diatur oleh TSH (Tyroid Stimulating
Hormone) Pembentukan TSH diatur oleh TRH (Tyroid
Releasing Hormone) dari hipotalamus TSH merangsang pelepasan T3 (Triiodotironin,
bentuk paling aktif) dan T4 (Tiroksin) Hipersekresi TSH menyebabkan hipertiroidisme
(takikardi, aritmia jantung, kurus, gelisah, tremor) Hiposekresi TSH menyebabkan hipotiroidisme
(bradikardia, perlambatan perkembangan mental)
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Pengobatan hipotiroidisme dapat diobati dengan levotiroksin (T4)
Pengobatan hipertiroidisme dapat dilakukan dengan :1. Pengambilan tiroid yang dapat dilakukan dengan bedah atau perusakan kelenjar tiroid2. Penghambatan sintesis hormon tiroid tioamid, propiltiourasil (PTU), metiazole
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Kelenjar Pankreas
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Homeostasis Glukosa
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Efek Insulin pada Kelenjar Target
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SEDIAAN INSULIN
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Tempat Penyuntikan Insulin
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KOMPLIKASI INSULIN HypoglycemicHypoglycemic reactions are the most common complication of
insulin therapy. They may result from a delay in taking a meal, inadequate carbohydrate consumed, unusual physical exertion, or a dose of insulin that is too large for immediate needs.
Rapid development of hypoglycemia in individuals with intact hypoglycemic awareness causes signs of autonomic hyperactivity, both sympathetic (tachycardia, palpitations, sweating, tremulousness) and parasympathetic (nausea, hunger) and may progress to convulsions and coma if untreated.
In patients with persistent, untreated hypoglycemia, the manifestations of insulin excess may develop—confusion, weakness, bizarre behavior, coma, seizures—
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Treatment Hypoglycemia All the manifestations of hypoglycemia are
relieved by glucose administration. To treat mild hypoglycemia in a patient
who is conscious and able to swallow, dextrose tablets, glucose gel, or any sugar-containing beverage or food may be given.
If more severe hypoglycemia has produced unconsciousness or stupor, the treatment of choice is to give 20–50 mL of 50% glucose solution by intravenous infusion over a period of 2–3 minutes.
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ORAL ANTIDIABETIC AGENT
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MK : 1.Merangsang sekresi
insulin dari kelenjar pankreas
2.Menurunkan konsentrasi serum glukagon
INSULIN SECRETAGOGUE - SULFONILUREA
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INSULIN SECRETAGOGUE - SULFONILUREA
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INSULIN SECRETAGOGUE - MEGLITINIDE
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INSULIN SECRETAGOGUE(D-PHENYLALANINE DERIVATES)
Nateglinide, a D-phenylalanine derivative, is the latest insulin secretagogue to become clinically available. Nateglinide stimulates very rapid and transient release of insulin from B cells through closure of the ATP-sensitive K+ channel. It also partially restores initial insulin release in response to an intravenous glucose tolerance test. This may be a significant advantage of the drug because type 2 diabetes is associated with loss of this initial insulin response.
Nateglinide is ingested just before meals. It is absorbed within 20 minutes after oral administration with a time to peak concentration of less than 1 hour and is hepatically metabolized by CYP2C9 and CYP3A4 with a half-life of 1.5 hours. The overall duration of action is less than 4 hours.
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BIGUANIDES (METFORMIN) MK : Bekerja langsung pada hepar, menurunkan
produksi glukosa hati. Tidak merangsang sekresi insulin oleh kelenjar pankreas.
ES : gastrointestinal (anorexia, nausea, vomiting, abdominal discomfort, diarrhea) and occur in up to 20% of patients.
Penggunaan : bersama makan Sediaan : Diabex, Glucophage, Gludepatic. Fixed Dose Combination : Glucovance
(metformin + Glyburid), metaglip (metformin + glipizid), avandamet (metformin + rosiglitazone)
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THIAZOLIDINDION MK : Meningkatkan kepekaan tubuh terhadap
insulin, dengan jalan berikatan dg PPARY (peroxisome protiferator activated receptor-gamma) di otot, jaringan lemak, dan hati untuk menurunkan resistensi insulin. TZD juga menurunkan kecepatan glikoneogenesis.
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GOLONGAN α-Glucosidase Inhibitor MK : menghambat enzim α-glukosidase
(maltase, isomaltase, glukomaltase, sukrose) mengurangi pencernaan karbohidrat kompleks dan absorbsinya mengurangi kadar glukosa post prandial. Diberikan pada suapan pertama setelah makan
Sediaan : Glucobay
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