antiemetik gastritis (b.happy) (1)
TRANSCRIPT
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Welcome to
my class!
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Manajemen Mual dan MuntahManajemen Mual dan MuntahAntiemetic
Mengurangi dan mencegah mual -muntah
Berefek sentral atau berefek lokal
Bervariasi tingkat efektivitasnya
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Letak aksi kerja dariLetak aksi kerja dari
Emetics/AntiemeticsEmetics/Antiemetics
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Vomiting Centre
(medulla)
Stomach
Small intestine
Higher cortical
centres
Chemoreceptor
Trigger Zone
(area prostrema,
4th ventricle)
Memory, fear, anticiation!ensory inut "ain, smell, sight#
!urgery
!urgery
Labrinths
Anaesthetics
Vomiting !e"le#
$euronal ath%ays
&actors %hich can
cause nausea ' vomiting
(hemotheray
(hemotheray
)adiotheray
*ioids
Sites of action of drugs
5HT3antagonists
Sphincter modulators
Histamine antagonistsMuscarinic antagonists
Gastroprokinetic
agents
BenzodiazepinesHistamine antagonists
Muscarinic antagonists
Dopamine antagonists
Cannabinoids
Vomiting :The act of vomiting and the sensation ofnausea that accompanies it are protective reexes thatserve to rid the stomach and intestine of toxic substances
and prevent their further ingestion
Antiemetics
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Area Tpe o" receptors Stimulus
(hemorecetor trigger +one"(#
a# .oamine .b# 012c# *ioid
3# (ancer chemotheray
# *ioids
4estibular nuclei a# Mscarinicb# 1istamine 13 3# Motion sickness
5haryn6 and 78 a# 012 3# (ancer chemotheray
# )adio theray
2# 7astroenteritis
(erebral corte6 3# !mell
# !ight
2# hought9# Anticiatory emesis
Serotonin $HT% receptor antagonists $HT% receptor
5henothia+ines .oamine .recetorsAntihistaminicAnticholinergic
!ubstituted ben+amides .oamine .recetors
Anticholinergic drugs Muscarinic recetors
Antihistaminic drugs 1istamine 13recetors
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8ndications of antiemetics8ndications of antiemetics
3- (hemotheray-induced vomiting
- 5ost irradiation vomiting
2- 5ostoerative vomiting
9- 4omiting of regnancy0- Motion sickness
Serotonin 5 HT3Antagonists:Dopamine D2Antagonist:
Antichoinergics:
7rou of drugs used as antiemetics
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:elomok antiemetik:elomok antiemetik
5henothia+ines "rochlorera+ine#
$onhenothia+ines " Metocloramide,
steroids e6; .e6amethasone#
!erotonin "0-12# recetor blockers
"ondasetron#
!ubstance 5/neurokinin 3 recetor
antagonists
Anticholinergics "scoolamine#
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Serotonin 5 HT3Antagonist
&otent antiemetics'echanism o" action
3- 5eriheral 0-12 recetor blockade on intestinal vagalafferents;
- (entral 0-12 recetor blockade in the vomiting center and
chemorecetor trigger +one
Antiemetic action is mainl against
Emesis mediated by vagal stimulation "e;g; ostoerative and
chemotheray#
High "irst pass metabolism
#creted b liver * +idne
$o dose reduction in renal insufficiency but needed in heatic
insufficiency
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Drugs Available
!" #ndansetron
2" $ranisetron
3" Doasetron
%" &aonosteron
Indications
!' (hemotherap) induced nausea andvomiting
2' postradiation nausea * vomiting
3' Vomiting of pregnanc)
%' &ostoperative vomiting
The most commonadverse e+ects are:
!, Headache and
di--iness2, (onstipation or
diarrhoea
Adverse Efects
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(orticosteroids(orticosteroids
(orticosteroids have antiemetic roerties
Mechanism of action< ossibly by
suressing eritumoral inflammationand rostaglandin roduction;
=se< to enhance efficacy of 012recetor
antagonists in the treatment ofchemotheray-induced vomiting;
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5henothia+ines5henothia+ines
5henothia+ines as rometha+ine are antisychoticagents
=se< (hemotheray-induced vomiting )adiotheray-induced vomiting ostoerative nausea and vomiting
Mechanism of the antiemetic action< inhibition ofcentral doamine, muscarinic and 13 histaminerecetors recetors
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ButyrohenonesButyrohenones
Butyrohenones as droeridole are antisychotic agents Mechanism of the antiemetic action< inhibition of central
doamine recetors
=se< (hemotheray-induced vomiting )adiotheray-induced vomiting ostoerative nausea and vomiting Adverse effects< droeridol may rolong the > inter,
therefore, it should not be used in atients %ith >rolongation "should only be used in atients %ho havenot resonded ade?uately to alternative agents#;
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!ubstituted Ben+amides!ubstituted Ben+amides
3- Metocloramide- rimethoben+amide
Mechanism of antiemetic action< (entraldoamine-recetor blockade
!ide effects< "mainly e6trayramidal#uick E+e
.osage< 4aries to individual; &asting effects lasts @-
9@ mins; 3 hour after meal effects u to 2 hours;Li?uid and o%der from more effective
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=lcer healing drugs=lcer healing drugsAcid secretion reducers
1istamine 1 recetor antagonists
(imetidine and ranitidine block the action of
histamine on the arietal cells and reduce acid
secretion)elieve ain and usually heal ulcers in 9- %eeks;
(ommon adverse reactions include diarrhoea,
constiation, headache, di++iness, rash and
confusion;
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!ucralfate!ucralfate
(omosed of sulhated sucrose andaluminium hydro6ide;
8n resence of acid undergoes chemical
reaction that results in sticky yello% %hite gelthat forms a rotective acid resistant shield
his barrier hastens healing of etic ulcers
by rotecting the mucosa for u to si6 hours
!hort term use u to C %eeks
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MisorostilMisorostil8ndicated for treatment of etic ulcers and
revention of gastric ulcers assoc %ith the useof $!A8.!;
Misorostil suresses gastric acid secretion
and thus hels to heal gastric ulcers
(an cause hyotension in atients %ith
cerebrovascular and coronary artery disease
Misorostil can induce remature labour and
may be teratogenic in large doses
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modifikasi gaya hidu ' menghindari obatenyebab ulcer "asirin ' $!A8.s lain,bishoshonat oral, :(l, engobatanimunosuresan#
Menghindari stress
!to merokok ' alkohol
!to kafein "stimulan asam lambung#
Menghindari makanan dan minuman soda
Menghindari makan malam
Terapi non farmakologi
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33 !*L=!8 (E7A1 7A$77=A$33 !*L=!8 (E7A1 7A$77=A$
5E$(E)$AA$5E$(E)$AA$Biasakan makan dengan teratur
:unyah makanan dengan baik suaya
en+im tialin dalam kelenjar ludah daatmelakukan fungsinya dengan semurna
angan makan terlalu banyak
angan berbaring setelah makan
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LanjutanFLanjutanF1indari %aktu makan yang terlalu ber-
dekatan suaya roses mencerna tidak
terganggu "interval -2 jam#
angan makan sambil minum "setia cairanyang dikonsumsi dengan makanan adat
akan mengurangi aktivitas cairan
encernaan yang terlibat dalam rosesencernaan#