prof. jimmy - obat gangguan haid.ppt
DESCRIPTION
obat gangguan haid yang diperlukan untuk penanganan pada pasien yang mengalami keterlambatan mendapatkan menstruasi dikarenakan mugkin adanya gangguan hormon.TRANSCRIPT
Obat-obat Gangguan HaidObat-obat Gangguan Haid
Kepustakaan
• Goodman and Gilman’s, The Pharmacological Basis Of Theurapeutics, Eleventh Ed, 2006
• Farmakologi Dan Terapi, Edisi 5, 2007
Gangguan Haid
AmenorrheaDysmenorrheaMenorrhagia
Gangguan Haid
Amenorrhea• Treatment depends on etiology.
Direct therapy to the underlying cause.
Amenorrhea• If normal physical examination with
secondary amenorrhea, consider administering medroxyprogesterone 10 mg daily for 5-10 days
Dysmenorrhea• Provide symptomatic relief with
nonsteroidal anti-inflammatory drugs (eg, naproxen, ibuprofen) at the first sign.
Dysmenorrhea• If nonsteroidal anti-inflammatory
therapy fails, consider oral contraceptive pills for 3-6 months. If this fails as well, look for secondary causes of dysmenorrhea.
Dysmenorrhea• Short-term use of selective
estrogen receptor modulators (SERMs), such as tamoxifen
Menorrhagia• Most cases of menorrhagia fall
under the category of DUB. Treatment of the underlying cause is necessary.
Menorrhagia• For patients with mild DUB,
provide reassurance and observation. Instruct the patient to keep a menstrual calendar. Consider iron supplementation and antiprostaglandin
Menorrhagia• For patients with moderate DUB,
prescribe combination oral contraceptive pills beginning with 4 monophasic 35-microgram pills a day and tapering down. Pills are usually continued for 6 months. Medroxyprogesterone alone may also be used. Oral iron and folic acid supplements are usefull
Menorrhagia• If DUB is severe, consider an
undiagnosed underlying disorder, such as von Willebrand disease (VWD) or factor VII deficiency.
Menorrhagia• IV Premarin every 4 hours until the
bleeding stops, up to 4 doses. Simultaneously administer a monophasic 35-microgram oral contraceptive pill every 6 hours for 24-48 hours and then twice daily to complete a 28-day course.
Menorrhagia• If Premarin does not stop the
bleeding after 4 doses, consider pelvic pathology. Examination under anesthesia and dilatation and curettage may be necessary.
Menorrhagia• An international expert of
obstetrician/gynecologists and hematologists has issued guidelines such as von Willebrand disease as a cause of menorrhagia and postpartum hemorrhage
Menorrhagia• An underlying bleeding disorder
should be considered when a patient has any of the following:
• Menorrhagia since menarche• Family history of bleeding disorders• Personal history of one or more of the following:
(1) notable bruising without known injury,
(2) bleeding of oral cavity or GI tract without obvious lesion, or
(3) epistaxis that persists more than 10 minutes
Menorrhagia• Recent literature (including
information from the American College of Obstetricians and Gynecologists Committee on Gynecologic Practice) favors the use of levonorgestrel intrauterine devices (eg, Progestasert, Mirena coil)
Menorrhagia• Surgical options for the
management of severe menorrhagia include thermal balloon endometrial ablation, transcervical resection of the endometrium (TCRE), and hysterectomy.
Hormon kelamin dan antagonisnya
• Estrogen dan antiestrogen : 1. a. Estrogen: estradiol, estradiol
valerate, estradiol cypionate, ethinyl estradiol, mestranol, quinestrol, estrone, estrone sulfate, equilin,
b, Senyawa nonsteroid dengan aktivitas estrogenik: diethylstilbesterol,
Obat-obat
p,p'‑DDT, bisphenol‑A, genistein. 2. Selective estrogen receptor
modulators (SERMS) : tamoxifen, raloxifene, toremifene.
3. Antiestrogen: clomiphene, fulvestrant
4. Estrogen syntesis inhibitors: fortnestane, exemestane, anastrozole, letrozole, vorozole
• Progestin dan antiprogestin : 1.a. Progestin: progesterone,
senyawa pregnane (17 alfa acetoxy progesterone), senyawa estranes (19 nortestosterone), senyawa gonane (norgestrel).
b. Steroid : medroxyprogesterone acetate (MPA), megestrol acetate., norethindrone acetate.
2. Antiprogestin: mifepristone, onapriston, (kombinasi antiprogestin‑prostaglandin: sulprostone, gemeprost, misoprostol)
• Kontrasepsi : a. Kombinasi oral (progestin
estrogen): monofasik, bifasik, trifasik.
b. Progestin only : oral, parenteral: MPA, implants: norethinrone
Estrogen-progestin
Endogenous hormon produce physiological actions:
- Developmental- Neuroendocrine for ovulation- Fertilitation- Mineral, carbohydrate, protein,
lipid
Estrogen
Two major uses: - combination oral contraceptive- MHT (menopausal hormone
therapy)
MHT
Vasomotor: hot flashes, inapropriate sweating, paresthesias
Osteoporosis: estrogens reduce bone resorption
Vaginal dryness and urogenital atrophy
Cardiovascular diseaseOthers: thinning of the skin etc
Menopausal Hormone Regiment
1960-1970 Estrogen Replacement Therapy (estrogen alone) increasing endometrial carcinoma
1980 Hormon Replacement Therapy (include progestin), now referred as Menopausal Hormon Therapy
Selective Estrogen Receptor Modulators and Anti-Estrogen
Antiresoptive effect on boneDecrease total cholesterol, LDL and
lipoprotein, but does not increase HDL and TG
Therapeutic Uses: breast cancer (tamoxifen), Osteroporosis (raloxifene), infertility (clomiphene)