pw toks obat
TRANSCRIPT
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TOKSIKOLOGI OBATTOKSIKOLOGI OBAT
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OBAT YG SERING OBAT YG SERING MENYEBABKAN KERACUNANMENYEBABKAN KERACUNAN
ANTIHISTAMINANTIHISTAMIN ANALGETIKAANALGETIKA VITAMIN, MINERAL VITAMIN, MINERAL OBAT FLUOBAT FLU HORMONHORMON ANTIBIOTIK INTERNALANTIBIOTIK INTERNAL
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NONO KRITERIA TOKSIK KRITERIA TOKSIK DOSISDOSIS
11 PRAKTIS NON TOKSIKPRAKTIS NON TOKSIK > 15 G/KG BB> 15 G/KG BB
22 SEDIKIT TOKSIKSEDIKIT TOKSIK 5 – 15 G/KG BB5 – 15 G/KG BB
33 TOKSISITAS SEDANGTOKSISITAS SEDANG 0,5 – 5 G/KG BB0,5 – 5 G/KG BB
44 SANGAT TOKSIKSANGAT TOKSIK 50-500 MG/KG BB50-500 MG/KG BB
55 TOKSIK EKSTREMTOKSIK EKSTREM 5-50 MG/KG BB5-50 MG/KG BB
66 SUPER TOKSIKSUPER TOKSIK < 5 MG/KG BB < 5 MG/KG BB
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INDEKS TERAPIINDEKS TERAPI = LD 50 / ED 50 = LD 50 / ED 50MAKIN MAKIN BESARBESAR MAKIN MAKIN AMANAMAN
URUTAN TOKSISITAS DITINJAU DARI URUTAN TOKSISITAS DITINJAU DARI RUTE PEMBERIAN:RUTE PEMBERIAN:
IV > INHALASI > IP > SC > IM > INTRA IV > INHALASI > IP > SC > IM > INTRA DERMAL > ORAL > TOPIKALDERMAL > ORAL > TOPIKAL
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EFEK EFEK TOKSISITASTOKSISITAS
OBATOBAT
EMESISEMESIS SALISILATSALISILAT
KONSTIPASIKONSTIPASI NARKOTIKANARKOTIKA
BRADICARDIBRADICARDI NARKOTIKA, SEDATIVENARKOTIKA, SEDATIVE
TACHICARDITACHICARDI AMFETAMIN, ATROPIN, AMFETAMIN, ATROPIN, SALISILAT, KOKAINSALISILAT, KOKAIN
MULUT KERINGMULUT KERING AMFETAMIN, ATROPIN, AMFETAMIN, ATROPIN, ANTIHISTAMIN, ANTIHISTAMIN, NARKOTIKNARKOTIK
ATAKSIAATAKSIA BARBITURAT, FENITOIN,BARBITURAT, FENITOIN,
HALUSINOGENHALUSINOGEN
KOMA, DEPRESIKOMA, DEPRESI A.HISTAMIN, A.PSIKOTIKA.HISTAMIN, A.PSIKOTIK
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PENANGANAN PENANGANAN KERACUNANKERACUNAN
PENILAIANPENILAIAN FUNGSI RESPIRASIFUNGSI RESPIRASI FUNGSI KARDIOVASKULARFUNGSI KARDIOVASKULAR GEJALA SSPGEJALA SSP GEJALA LAINGEJALA LAIN PENENTUAN KERACUANANPENENTUAN KERACUANAN
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FAKTOR YGFAKTOR YG MEMPENGARUHIMEMPENGARUHI TOKSISITASTOKSISITAS KOMPOSISIKOMPOSISI DOSISDOSIS RUTE PEMBERIANRUTE PEMBERIAN METABOLISME TOKSIKMETABOLISME TOKSIK KONDISI KESEHATANKONDISI KESEHATAN USIA KEMATANGANUSIA KEMATANGAN KONDISI NUTRISIKONDISI NUTRISI GENETIKGENETIK KELAMINKELAMIN LINGKUNGANLINGKUNGAN
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FAKTOR YANG MENENTUKAN FAKTOR YANG MENENTUKAN TOKSISITASTOKSISITAS
LD 50LD 50
EFEK SAMPINGEFEK SAMPING
KECEPATAN TIMBULNYA EFEKKECEPATAN TIMBULNYA EFEK
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CARA PENANGANANCARA PENANGANAN
PENCUCIAN/LAVAGEPENCUCIAN/LAVAGE EMESISEMESIS ADSORBENTADSORBENT KATARTIKKATARTIK DEMULSENDEMULSEN DEKONTAMINASI TOPIKALDEKONTAMINASI TOPIKAL MENINGKATKAN ELIMINASI ZAT TOKSIKMENINGKATKAN ELIMINASI ZAT TOKSIK ANTIDOTANTIDOT
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PENCUCIANPENCUCIAN
JK RACUN HRS SGR DIKELUATKAN DR JK RACUN HRS SGR DIKELUATKAN DR LAMBUNGLAMBUNG
INDIKASIINDIKASI 1010TIDAK SADAR/SETENGAH SADARTIDAK SADAR/SETENGAH SADAR REFLEKS MENELAN HILANG: REFLEKS MENELAN HILANG:
S.IPECAC TIDAK BISAS.IPECAC TIDAK BISA SANGAT TOKSIK & BANYAKSANGAT TOKSIK & BANYAK
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KI :ZAT KOROSIFKI :ZAT KOROSIFPASIEN KEJANGPASIEN KEJANG
CAIRAN PENCUCIANCAIRAN PENCUCIAN NaHCO3NaHCO3 Larutan Garam CaLarutan Garam Ca Larutan As.TanatLarutan As.Tanat KMNO4KMNO4 NaCl FisiologisNaCl Fisiologis AirAir
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EMESISEMESIS
JK RACUN MASIH DI SAL CERNAJK RACUN MASIH DI SAL CERNASIRUP IPECACSIRUP IPECACAPOMORFINAPOMORFIN
ALTERNATIF LAINALTERNATIF LAINLARUTAN SABUNLARUTAN SABUNRANGSANGAN MEKANIKRANGSANGAN MEKANIKKI: KI: OBAT KONVULSANOBAT KONVULSAN
TDK SADAR/REFLEKS MENELAN –TDK SADAR/REFLEKS MENELAN –PENYAKIT CARDIOVASKULARPENYAKIT CARDIOVASKULAREMPISEMAEMPISEMA
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ADSORBENADSORBENJK RACUN DPT DIABS D/ ABSORBENJK RACUN DPT DIABS D/ ABSORBEN
KARBON AKTIFKARBON AKTIFKAOLINKAOLINPEKTINPEKTINATALPUGITATALPUGITKOLESTIRAMINKOLESTIRAMIN
ABSORBSI < :TOLBUTAMID, ZAT TDK ABSORBSI < :TOLBUTAMID, ZAT TDK LRT AIR LRT AIR
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KATARTIKJK DIDUGA ZAT TOKSIK SDH MSK USUS
MgSO4 Mg SITRAT Na SULFAT Na FOSFAT SORBITOL
Sbg pencahar
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DEMULSEN• ES KRIM• SUSU• PUTIH TELUR
Lapisi muk zat racun yg korosif
DEKONTAMINASI TOPIKAL
• AIR• SABUN
u/ zat iritan
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PENINGKATAN ELIMINASIPENINGKATAN ELIMINASI
DIURETIK KUATDIURETIK KUAT Yg dpt dikeluarkan diuretik kuatYg dpt dikeluarkan diuretik kuat
amfetamin,penicillin,salisilat,sulfonamidaamfetamin,penicillin,salisilat,sulfonamida
KI : ACETAMINOPHEN,FENOTIAZINKI : ACETAMINOPHEN,FENOTIAZIN A.DEPRESSAN TRISIKLIK,barbiturat krj A.DEPRESSAN TRISIKLIK,barbiturat krj
pendekpendek**DIALISISDIALISIS*PENGASAMAN/PEMBASAAN URIN*PENGASAMAN/PEMBASAAN URIN
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ANTIDOTANTIDOT
KIMIAKIMIA RESEPTORRESEPTOR DISPOSIONALDISPOSIONAL FUNGSIONAL/FISIOLOGISFUNGSIONAL/FISIOLOGIS
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ANTIDOTANTIDOTATROPIN----------------ATROPIN----------------DIAZEPAM--------------DIAZEPAM--------------DEKTROSE-------------DEKTROSE-------------ADRENALIN------------ADRENALIN------------DOPAMIN---------------DOPAMIN---------------NALOKSON-------------NALOKSON-------------NITROPRUSID----------NITROPRUSID----------PROTAMIN SULFAT--PROTAMIN SULFAT--VIT K-----------------VIT K-----------------
ASETIL SISTEIN-----ASETIL SISTEIN-----
RACUN/GEJALARACUN/GEJALAKOLINESTERASE INHKOLINESTERASE INHSTIMULAN SSPSTIMULAN SSPHIPOGLIKEMIKHIPOGLIKEMIKANAPHYLAKSIISANAPHYLAKSIISHIPOTENSIHIPOTENSIOPIOIDOPIOIDHIPERTENSIHIPERTENSIHEPARINHEPARINANTIKOAGULANORALANTIKOAGULANORALACHETAMINOPHENACHETAMINOPHEN
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KERACUNAN ACETAMINOPHEN
MK: METABOLIT REAKTIF IK SEL NECROSIS HB MET HB(TDK IK O2)O2 PAR
HB (ENZ MET HB REDUKTASE) KOFAKTOR : GLUTATION
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• Anj Anj nekrosis hepatik nekrosis hepatik• KucKuc Met Hemoglobinemia Met Hemoglobinemia
DOSIS TOKSIKDOSIS TOKSIK
ANJ : 150 MG/KGANJ : 150 MG/KG
KUC : 50 MG/KGKUC : 50 MG/KG
(DOSIS AN: 80 MG(DOSIS AN: 80 MG
REG: 325-500MG)REG: 325-500MG)
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GEJALAGEJALA► ANJ: - DEPRESIANJ: - DEPRESI
- MUNTAH- MUNTAH - SKT ABD- SKT ABD - URIN,SERUM: GELAP- URIN,SERUM: GELAP - MATI ( 2-5 HR)- MATI ( 2-5 HR)► KUCKUC
- ANOREKSI,SALIVASI,VOMIT- ANOREKSI,SALIVASI,VOMIT - DEPRESI- DEPRESI - METHBNEMIA, HEMOGLOBINURIA- METHBNEMIA, HEMOGLOBINURIA - MEMBRAN CYANOTIK- MEMBRAN CYANOTIK - URIN, DARAH GELAP- URIN, DARAH GELAP - WAJAH EDEMA- WAJAH EDEMA - MATI 18-36 J- MATI 18-36 J
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PROGNOSIS: JELEKPROGNOSIS: JELEK TREATMENTTREATMENT
- <4J: EMESIS, GASTRIC LAVAGE, - <4J: EMESIS, GASTRIC LAVAGE, ACTIVATED CHARCOALACTIVATED CHARCOAL KUC: YOHIMBINKUC: YOHIMBIN ANJ: APOMORPHINANJ: APOMORPHIN
-GROUP SULFHYDRYL:N- -GROUP SULFHYDRYL:N- ACETILCYSTEINE 140 MG/KGACETILCYSTEINE 140 MG/KG - VIT C- VIT C
- SUPPORTIVE THERAPY - SUPPORTIVE THERAPY -INFUSE : DECTROSE 2,5%-INFUSE : DECTROSE 2,5% -OXYGEN:-OXYGEN: -TRANSFUSI DRH-TRANSFUSI DRH
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ASPIRIN TOXICOSISASPIRIN TOXICOSIS
KUC > SERING DRPD ANJKUC > SERING DRPD ANJ C/ KUC:DEF/AKT C/ KUC:DEF/AKT GLUCORONYL GLUCORONYL
TRANSFERASETRANSFERASE < < (GT : DETOX & EKS ASPIRIN)(GT : DETOX & EKS ASPIRIN)EFEK TOKSIK:EFEK TOKSIK:
- TEKAN SUTUL- TEKAN SUTUL- HAMB AGREGASI TROMBOSIT- HAMB AGREGASI TROMBOSIT- METABOLIC ACIDOSIS- METABOLIC ACIDOSIS- RENAL DISEASE- RENAL DISEASE- GASTRIC ULCERASI- GASTRIC ULCERASI
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DOSIS TOXIC:DOSIS TOXIC:
- ANJ : 30 MG /KG/HR- ANJ : 30 MG /KG/HR
- KUC : 25 MG/KG/HR- KUC : 25 MG/KG/HR
(ANAK : 81 MG(ANAK : 81 MG
REG : 325- 500 MG)REG : 325- 500 MG)
GJL:-AKUT:GJL:-AKUT:
DEPRESI, ANOREKSI, DEPRESI, ANOREKSI,
HIPERPIREXIA, VOMIT, ATAKSIA, HIPERPIREXIA, VOMIT, ATAKSIA,
COMA, MATICOMA, MATI
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KRONIK: KRONIK:
GASTRIK ULCER, PERFORASI, GASTRIK ULCER, PERFORASI, HEPATOTIKSIK, SUPRESI SUTULHEPATOTIKSIK, SUPRESI SUTUL
TREATMENTTREATMENT
1. 6-12 J : EMETIK,GASTREK 1. 6-12 J : EMETIK,GASTREK LAVAGE, LAVAGE,
ACT CHARCOAL, SALINE ACT CHARCOAL, SALINE
CATARTIKCATARTIK
2. DIURESIS : DIURETIK KUAT 2. DIURESIS : DIURETIK KUAT
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IBUPROFENIBUPROFEN
NSAID YG TDK DIREKOMENDASI UTK NSAID YG TDK DIREKOMENDASI UTK PETS PETS IT SEMPIT IT SEMPIT
TOKSISITAS:TOKSISITAS:- 150 mg/kg- 150 mg/kg vomit, gastric ulcer vomit, gastric ulcer
- 300 mg/kg - 300 mg/kg ggl ginjal ggl ginjal PROG : JLKPROG : JLK TREAT: 1. EMETIK, GASTRIK L, A TREAT: 1. EMETIK, GASTRIK L, A
CHARCOALCHARCOAL 2. support: infus, diuresis2. support: infus, diuresis
3. simpt: sucralfat, ranitidin, 3. simpt: sucralfat, ranitidin, misotrostolmisotrostol g.ulcer g.ulcer
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ANTICOAGULANT
MK : -INH ENZ PD SINTESIS VIT K - INH FACT COAG PROD VIT K
TOXIC DOSE* ANJ : 5-300 MG/KG
(1-5 MG/KG/HR 5-15 HR)* KUC: 5-30 MG/KG
(1 MG/KG/HR 5 HR) GJL:- DEPRESI,LEMAH
- HEMATEMESIS,HEMATURIA,HEMORRHAGE - MATI HEMORRHAGE D/PLEURAL CAVITY
DX:-HISTORY - SCREENING KOAG: BLEEDING TIME, COAG TIME - ANALISIS A.COAG KIMIA
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• TREATMENT1. INDUKSI EMESIS, GASTRIC LAVAGE, ACTIVED
CHATCOAL, CATHARTIC2. ANTIDOTE: VIT K3. TREAT CLINICAL SIGN
- INTRAPULMONARY HEMORRHAGE: TRANSFUSI PLASMA, O2, TDK BOLEH DIBERI FUROSEMIDE INH FS PLATELET
- HIPOVOLEMIC SHOCK: INFUSE,TRANSF DRH, KORTICOSTEROID,
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A.HISTAMIN&DECONGESTAN
DX: SEJARAH PSEUDOEPHEDRIN,(PHENYLPROPANOLAMINE)/PPA,DIPHENHYDRAMINE, CHLORPHENIRAMINE
GJL:- DEPRESI, GG RESP,
- HIPEREXCITABILITY - TREMOR, SEIZURES, HIPERACTIVITY
- VOMIT, MIDRIASIS, HIPERTERMIA - DISORIENTASI
- BRADICARD/TACHICARD
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PROG: BAIK TREAT:
1. < 1 J INTAKEEMESIS
2. ACTIVATED CHARCOAL
3. SUPPORTIVE: INFUSE, O2
4. OBAT SEDATIVE HIPERACVTIVE
(DIAZEPAM,PHENOBARBITAL)
5. PROPANOLOLTACHYCARDI
6. ATROPINE BRADYCARD