farmakologi klinik
DESCRIPTION
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RahmatiniBagian Farmakologi & Terapi
Fakultas Kedokteran Universitas Andalas
FARMAKOLOGI KLINIK
WHO ( 1988) Disiplin dalam bidang kedokteran berdasarkan
prinsip ilmiah, menyatukan keahlian farmakologi &
keahlian klinik dengan tujuan meningkatkan manfaat &
keamanan obat
FARMAKOLOGI KLINIK
Terapi Efektif, Aman , Rasional
TUJUAN
RATIONAL DRUG USE
Benefit – Risk - Cost
F.Kinetika F Dinamika F Ekonomi
Ratio
PHARMACOLOGICAL ASPECTS IN CLINICAL PRACTICE
PharmacodynamicPharmacokinetic
How drugs actThe dynamics of drug conc. in
the body
* Absorption / bioavailability
* Distribution
* Biotransformation
* Excretion
Kelemahan bekal pengetahuan selama pre-service and in service
Aktivitas promosi yang berlebihan Rasa tidak aman (insecurity) krn ketidak
pastian diagnostik Rasa gengsi up date Sistim suplai obat yang tidak baik Beban pelayanan yang terlalu berat Kurangnya buku pedoman pengobatan Tekanan dan permintaan pasien, dll….
Pemakaian antibiotika untuk ISPA non bakteri
Pemakaian multivitamin untuk indikasi yang tidak jelas
Pemakaian steroid utk terapi simtomatik berbagai kondisi
Pemakaian injeksi tanpa indikasi yang jelas
Pemakaian antibiotika profilaksis utk semua tindakan bedah , dll….
THERAPEUTIC DRUG MONITORING (TDM)
Measuring the plasma drug conc.
Provide useful information about the adequacy of the dosage
regimen or the likehood toxicity
Therapeutic Drug Monitoring (TDM)
Ph kinetic Ph dynamic
Drug-interaction
• Therapeutic response• Side effects• Toxic effects
• Measuring/ interpreting
plasma drug conc.
Dru
g co
nc. (
mg /
l)
Time (hour)
10
20
30
40
1 2 3 4
Therapeutic level
Low therapy
Drug toxicity
Time-drug conc. relationship
m.e.c
1. Narrow margin of safety drugs
2. Drugs for prevention/ therapy of life threatening diseases or life saving drugs
4. Potent drugs drug amount is very small
5. Drugs that show variability of drug conc. in plasma
Therapeutic Drug Monitoring (TDM)
3. Difficulty in ditinguishing between the effects of a disease and the toxic effects of a drug
Factors that modify drug plasma concentration for a given dose
• Drug formulation• Drug interaction
• Environmental factors• Genetic variation
• Renal and hepatic function
Reasons for monitoring drug treatment
1. To see whether there is therapeutic response
2. To assess drug toxicity
3. To assess compliance
Examples of difficulty in ditinguishing between the effects of a disease and
the toxic effects of a drug
Digoxin toxicity Congest.Heart Failure
Nausea / anorexia / arrythmias
1.
2. Gentamycin toxicity Gram (–) septicaemia
Renal damage
Pharmacokinetic parameters
Cmax (peak)
Half life
Time Cmin (trough)
Dru
gs- p
lasm
a c
onc.
AUC 24
Dru
g co
nc. (
mg /
l )
5
10
20
642Hours
Visualisation of half-life
2.5
t ½ t
½
t ½
First order elimination of a drug (t ½ : 2 hours)
The plasma conc. falls by half each half-life
Clinical application of half life (t½)
* Designing drug dosage regimen
* Determining time to reach steady state drug level which show clinical effect
* Determining time to reach the drug level which have no clinical effect anymore
CONSIDERATION
Ph’kinetic Ph’dynamic Ph’economic
RATIONAL & GOOD CLINICAL THERAPY
Tidak ada seorang jiwa pun, kecuali ada penjaganya
(Q:S : At Toriq:4)