Download - HEMATOLOGI BTM
-
8/16/2019 HEMATOLOGI BTM
1/26
OBAT YANG BEKERJAOBAT YANG BEKERJA
PADA SISTEMPADA SISTEMHEMATOLOGIK HEMATOLOGIK Dr.RAHMATINI, M KesDr.RAHMATINI, M Kes
Bagian Farmak!gi " Tera#iBagian Farmak!gi " Tera#iFak$!%as Ke&k%eran 'nan&Fak$!%as Ke&k%eran 'nan&
-
8/16/2019 HEMATOLOGI BTM
2/26
HEMOSTASISHEMOSTASIS
Prses #eng(en%ian #er&ara(an se)araPrses #eng(en%ian #er&ara(an se)ara
s#n%an #a&a #em*$!$( &ara( +angs#n%an #a&a #em*$!$( &ara( +ang
)e&era.)e&era.
Fak%r +ang *er#eran Fak%r +ang *er#eran
-.Pem*$!$( &ara(-.Pem*$!$( &ara(
.Trm*si%.Trm*si% /.Fak%r #em*ek$an/.Fak%r #em*ek$an
-
8/16/2019 HEMATOLOGI BTM
3/26
-
8/16/2019 HEMATOLOGI BTM
4/26
DEFINISIDEFINISI
An%i kag$!an An%i kag$!an
O*a% +ang meng(am*a% #em*en%$kanO*a% +ang meng(am*a% #em*en%$kan
*ek$an &ara( &gn men)ega(*ek$an &ara( &gn men)ega(
#em*en%$kan 0*rin +ang mer$#akan#em*en%$kan 0*rin +ang mer$#akan
*a(an esensia! $n%$k #em*en%$kan*a(an esensia! $n%$k #em*en%$kan
%rm*$s.%rm*$s.
-
8/16/2019 HEMATOLOGI BTM
5/26
DEFINISIDEFINISI
Trm*!i%ik Trm*!i%ik
O*a% +ang meng(an)$rkan *ek$anO*a% +ang meng(an)$rkan *ek$an
&ara( 2 mem#er)e#a% &egra&asi&ara( 2 mem#er)e#a% &egra&asi0*rin0*rin
&an 0*ringen !e( #!asmin&an 0*ringen !e( #!asmin
se(inggase(inggamem*an%$ !ar$%n+a *ek$an &ara(3mem*an%$ !ar$%n+a *ek$an &ara(3
-
8/16/2019 HEMATOLOGI BTM
6/26
ANTI TROMBOTIK ANTI TROMBOTIK
4 O*a% an%i #!a%e!e%4 O*a% an%i #!a%e!e%
4 an%i agregasi %rm*si%,4 an%i agregasi %rm*si%,
men)ega( #er!eka%an 2a&(esi3men)ega( #er!eka%an 2a&(esi3#!a%e!e% &engan &in&ing#!a%e!e% &engan &in&ing
#em*$!$( &ara( +ang )e&era#em*$!$( &ara( +ang )e&era
a%a$ &engan #!a%e!e% !ainn+a.a%a$ &engan #!a%e!e% !ainn+a.
-
8/16/2019 HEMATOLOGI BTM
7/26
DEFINISIDEFINISI
Hems%a%ik Hems%a%ik
O*a% +ang &a#a%O*a% +ang &a#a%
meng(en%ikanmeng(en%ikan#er&ara(an#er&ara(an
-
8/16/2019 HEMATOLOGI BTM
8/26
An%i kag$!anAn%i kag$!an
In&ikasi In&ikasi
men)ega( %er*en%$k " me!$asmen)ega( %er*en%$k " me!$as
n+a %rm*$s5 em*!$sn+a %rm*$s5 em*!$s in 6i6 "in 6i6 "
in 6i%rin 6i%r
K!asi0kasi -.He#arinK!asi0kasi -.He#arin
.An%i kag$!an ra!.An%i kag$!an ra!
/.An%i kag$!an #engika% in/.An%i kag$!an #engika% in
ka!si$mka!si$m
-
8/16/2019 HEMATOLOGI BTM
9/26
He#arinHe#arin
Ter&iri &ari En&gen " eksgen Ter&iri &ari En&gen " eksgen
Mekanisme ker7a Mem#er)e#a%Mekanisme ker7a Mem#er)e#a%
inak%i6asiinak%i6asi
8ak%r #em*ek$ &ara(8ak%r #em*ek$ &ara(
in 6i%r 9 %i&ak mer$*a( (asi! #emin 6i%r 9 %i&ak mer$*a( (asi! #em
&ara(&ara(
9 Mer$*a( *en%$k eri%rsi% " !e$9 Mer$*a( *en%$k eri%rsi% " !e$
ksi%ksi%
-
8/16/2019 HEMATOLOGI BTM
10/26
He#arinHe#arin
Mni%r #eng*a%an Mni%r #eng*a%an
-.Ke%e#a%an &sis-.Ke%e#a%an &sis
.Pem &ara( *erka!a se!ama.Pem &ara( *erka!a se!ama
#eng*a%an#eng*a%an
Parame%er )!%%ing %ime5 :ak%$ #emParame%er )!%%ing %ime5 :ak%$ #em
*ek$an, PTT, APTT*ek$an, PTT, APTT
Farmakkine%ika Farmakkine%ika
Ora!Ora! a*sr*si 9 ,a*sr*si 9 , SK,I 6ena, imSK,I 6ena, im
-
8/16/2019 HEMATOLOGI BTM
11/26
He#arinHe#arin
E8ek sam#ing E8ek sam#ing
Per&ara(an sa!$ran )erna "Per&ara(an sa!$ran )erna "
(ema%$ria(ema%$ria Reaksi (i#ersensi%i8 2&emam,Reaksi (i#ersensi%i8 2&emam,
menggigi!, $r%ikaria, s+k ana0!ak%ik3menggigi!, $r%ikaria, s+k ana0!ak%ik3
Mia!gia, s%e#rsisMia!gia, s%e#rsis #em* 7k#em* 7k#an7ang, %rm*si%#enia#an7ang, %rm*si%#enia
-
8/16/2019 HEMATOLOGI BTM
12/26
He#arinHe#arin
Kn%ra in&ikasi ;Kn%ra in&ikasi ;
-.Per&ara(an5 ke)en&r$ngan-.Per&ara(an5 ke)en&r$ngan
#er&ara(an#er&ara(an
.Ps% #erasi 2ma%a, %ak " M.Ps% #erasi 2ma%a, %ak " M
s#ina!iss#ina!is
/.Ps% !$m*a! #$ngsi, anes%esi/.Ps% !$m*a! #$ngsi, anes%esi
-
8/16/2019 HEMATOLOGI BTM
13/26
-
8/16/2019 HEMATOLOGI BTM
14/26
He#arinHe#arin
In%ksikasi In%ksikasi
Per&ara(an ringan s%# (e#arinPer&ara(an ringan s%# (e#arin
Per&ara(an *era% an%agnisPer&ara(an *era% an%agnis(e#arin(e#arin
e? #r%amin s$!8a%e? #r%amin s$!8a% mengika%5mengika%5
mengmeng inak%i6asi (e#arininak%i6asi (e#arin
-
8/16/2019 HEMATOLOGI BTM
15/26
An%i kag$!an ra!An%i kag$!an ra!
Ter&iri &ari Ter&iri &ari
< (i&rksi k$marin,:ar8arin< (i&rksi k$marin,:ar8arin
Mekanisme ker7a an%agnis @i% K Mekanisme ker7a an%agnis @i% K 6i% K mer$#akan k8ak%r &a!am6i% K mer$#akan k8ak%r &a!am
ak%i6asiak%i6asi
8ak%r #em*ek$ &ara( II, @II, I,8ak%r #em*ek$ &ara( II, @II, I,
-
8/16/2019 HEMATOLOGI BTM
16/26
An%i kag$!an ra!An%i kag$!an ra!
Farmakkine%ikaFarmakkine%ika
E8ek n+a%a se%e!a( -9< 7amE8ek n+a%a se%e!a( -9< 7am
Res#n &i#engar$(i !e( Res#n &i#engar$(i !e( 9 as$#an 6i%amin K 9 as$#an 6i%amin K
9 7$m!a( !emak &a!am makanan9 7$m!a( !emak &a!am makanan
9 in%eraksi *a%9 in%eraksi *a% 9 gene%ik9 gene%ik
-
8/16/2019 HEMATOLOGI BTM
17/26
An%i kag$!an ra!An%i kag$!an ra!
Se&iaan Se&iaan
&ik$mar!, :ar8arin&ik$mar!, :ar8arin ra!, I , Ira!, I , I
6ena6ena
e8ek sam#ing e8ek sam#ing
-.Per&ara(an-.Per&ara(an !en&ir, k$!i%, sa!!en&ir, k$!i%, sa!
)erna,)erna, sa! kemi(sa! kemi(
Le$k#enia, &emam, $rin 7inggaLe$k#enia, &emam, $rin 7ingga
-
8/16/2019 HEMATOLOGI BTM
18/26
An%i kag$!an ra!An%i kag$!an ra!
Kn%ra in&ikasi Kn%ra in&ikasi
-. Pen+aki% #er&ara(an-. Pen+aki% #er&ara(an
. ani%a (ami!. ani%a (ami! /. Pa+a( 7an%$ng/. Pa+a( 7an%$ng &sis&sis
&i%$r$nkan&i%$r$nkan
-
8/16/2019 HEMATOLOGI BTM
19/26
An%i kag$!an #engika% inAn%i kag$!an #engika% in
ka!si$mka!si$m
-.Na%ri$m si%ra%-.Na%ri$m si%ra%
.Asam ksa!a%.Asam ksa!a%
/.Na%ri$m e&e%a%/.Na%ri$m e&e%a%
-
8/16/2019 HEMATOLOGI BTM
20/26
TROMBOLITIK TROMBOLITIK
Me!ar$%kan %rm*$s +ang s$&a(Me!ar$%kan %rm*$s +ang s$&a(
%er*en%$k%er*en%$k
Pem*erian se&ini m$ngkinPem*erian se&ini m$ngkin
E? S%re#%kinase,$rkinase &!!E? S%re#%kinase,$rkinase &!!
In&ikasiIn&ikasi
In8ark mikar&In8ark mikar& Trm*sis 6ena Trm*sis 6ena
Em*!i #ar$Em*!i #ar$
-
8/16/2019 HEMATOLOGI BTM
21/26
An%i Trm*%ikAn%i Trm*%ik
E? As#irin, k!#i&gre!,E? As#irin, k!#i&gre!,
Di#iri&am!, &eks%ran,Di#iri&am!, &eks%ran,
Tik!#i&in, #rs%asik!in 2PGI93. Tik!#i&in, #rs%asik!in 2PGI93.As#irin 2ase%sa!3As#irin 2ase%sa!3
Meng(am*a% sin%esis %rm*ksan A Meng(am*a% sin%esis %rm*ksan A
Meng(am*a% enCim sik!ksigenaseMeng(am*a% enCim sik!ksigenase Se&iaan - mgSe&iaan - mg
-
8/16/2019 HEMATOLOGI BTM
22/26
ANTI TROMBOTIK ANTI TROMBOTIK
K!#i&gre!K!#i&gre!
Dsis +ang &ig$nakan = mg5(ari,Dsis +ang &ig$nakan = mg5(ari,
ka&ang &ikm*inasi &engan as#irinka&ang &ikm*inasi &engan as#irin
In&ikasi men)ega( *er$!angn+aIn&ikasi men)ega( *er$!angn+a
s%rkes%rke
-
8/16/2019 HEMATOLOGI BTM
23/26
HEMOSTATIK HEMOSTATIK
O*a% $n%$k meng(en%ikan #er&ara(anO*a% $n%$k meng(en%ikan #er&ara(an
Per&ara(an ke)i! Per&ara(an ke)i!
9Penekanan, #en&inginan,9Penekanan, #en&inginan,ka$%erisasika$%erisasi
Per&ara(an !$as Per&ara(an !$as
9Hems%a%ik Lka!9Hems%a%ik Lka! Sis%emikSis%emik
-
8/16/2019 HEMATOLOGI BTM
24/26
-
8/16/2019 HEMATOLOGI BTM
25/26
Hems%a%ik sis%emikHems%a%ik sis%emik
Trans8$si &ara( Trans8$si &ara( #er&ara(an s%##er&ara(an s%#
karenakarena
2Fak%r #em*ek$ !engka#32Fak%r #em*ek$ !engka#3
Fak%r an%i (em0!ik 2Fak%r @III3Fak%r an%i (em0!ik 2Fak%r @III3
Km#!ek 8ak%r I,@i%amin K Km#!ek 8ak%r I,@i%amin K
Asam aminka#ra%Asam aminka#ra%Asam %raneksama%Asam %raneksama%
-
8/16/2019 HEMATOLOGI BTM
26/26
REFERENSIREFERENSI
Farmak!gi " Tera#i FK'IFarmak!gi " Tera#i FK'I
H$man P(arma)!g+,Br&+H$man P(arma)!g+,Br&+ et alet al
E%)E%)