obat system respirasi
TRANSCRIPT
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OBAT SISTEM RESPIRASI
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SISTIM RESPIRATORIKSISTIM RESPIRATORIK
SALURAN NAFAS ATAS.SALURAN NAFAS ATAS.• Udara melalui lubang hidung / mulut Udara melalui lubang hidung / mulut
ke pharynxke pharynx larynx larynx trakhea untuk selanjutnya ke trakhea untuk selanjutnya ke paru.paru.
• Penyakit yang tersering Infeksi Saluran Nafas AtasPenyakit yang tersering Infeksi Saluran Nafas Atasbatuk, pilekbatuk, pilek
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SISTIM RESPIRATORIKSISTIM RESPIRATORIK
SALURAN NAFAS BAWAHSALURAN NAFAS BAWAH• udara melalui trakhea udara melalui trakhea bronkhus bronkhus bronkhioli bronkhioli
alveolialveoli
• Penyakit yang sering ASMA / COPDPenyakit yang sering ASMA / COPDasma bronkhialeasma bronkhialebronkhitis kronisbronkhitis kronisemfisemaemfisema
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SISTIM RESPIRATORIKSISTIM RESPIRATORIK
Sistim respiratorik berakhir di alveoli dimanaSistim respiratorik berakhir di alveoli dimanaoksigen berdifusi dari alveoli ke kapiler pulmoner oksigen berdifusi dari alveoli ke kapiler pulmoner
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SALURAN NAFAS ATASrhinitis, pharyngitis, laryngitis
• Simptomatik - antihistamin- dekongestan- antitusif- ekspektoran- mukolitik
• Kausatif - antibiotik
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ANTIHISTAMIN• Chlorpheniramin maleat (chlortrimeton=ctm)• Diphenhydramin (delladryl, benadryl)• Prometazin (Phenergan)• Cetirizine• Loratadin
DEKONGESTAN : Agonis adrenergik • Ephedrin,
pseudoephedrin• Phenylpropanolamin
(PPA)• Phenylephrin
• vasokonstriksi• mukosa & sekresi • hidung longgar
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ANTITUSIF
• Menekan reflex batuk di pusat batuk /SSP• Indikasi : batuk non produktif/ iritasi• Contoh obat :
- narkotik kodein- non narkotik noskapin
dekstrometorphan• Efek samping : - depresi - konstipasi (narkotik)• Kontraindikasi : ?
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EKSPEKTORAN
• Merangsang pengeluaran sekret/ mukus batuk• Indikasi batuk produktif• Contoh obat : - ipekak
- amonium klorida (NH4Cl) - Gliseril guaiakolat
• Mukus kental, kuning mukolitik antibiotik
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MUKOLITIK
• Mengencerkan sekret sal.nafas memecah mukoprotein & mukopolisakarida sputum• Contoh obat : - bromheksin
- ambroxol - asetilcystein
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OBAT-OBAT ASMA BRONKHIALE
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PROSES ASMA
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PATOFISIOLOGI ASMA BRONKHIALE
• Penyakit inflamasi kronik sal.nafas (sel-sel inflamasi)• Gejala - hiperresponsif bronkhus thd stimuli penyempitan bronkhus• Gamb.patologi * bronkhokonstriksi
* penebalan mukosa ok edema & infiltrasi sel * sekresi mukus >
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Gambaran klinik asma bronkhialeGambaran klinik asma bronkhiale
1.1. Acute attacks of dyspnea associated Acute attacks of dyspnea associated with acute airway obstruction due to with acute airway obstruction due to contraction of airway smooth contraction of airway smooth musclemuscle
2.2. Mucus hypersecretionMucus hypersecretion, which may , which may lead to mucus plugginglead to mucus plugging
3.3. Airway inflammationAirway inflammation
4.4. Bronchial hyperresponsivenessBronchial hyperresponsiveness
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Triger asma bronkhialeTriger asma bronkhiale
a. Allergensa. Allergensb. Chemical irritantsb. Chemical irritantsc. Dust, smokesc. Dust, smokesd. Coldd. Colde. Post-exercisee. Post-exercisef. Psychogenicf. Psychogenicg. Post-coughingg. Post-coughingh. Post-hyperinflationh. Post-hyperinflationi. Post-laughteri. Post-laughter
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Ag (polutan, alergen)
Ag-Ab/IgE di mast cell
MEDIATOR
Early response : Late response : Bronchoconstriction Inflamation
Symptom Hyperreactivity
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TERAPI
Ag (polutan, alergen) hindari
Ag-Ab/IgE di mast cell kromolin, steroidMEDIATOR
• agonis, steroid• teofilin,• anti kholinergik
Early response : Late response : Bronchoconstriction Inflamation
Symptom Hyperreactivity
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TERAPI• 1. BRONKHODILATOR• 2. ANTIINFLAMASI• 3. LAIN-LAIN* mukolitik
* antitusif, ekspektoran
* antihistamin* antibiotik jk.perlu* preventif kromolin
steroid
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BRONKHODILATOR
1.SIMPATOMIMETIK/ ADRENERGIK- adrenalin/ epinefrin- efedrin- isoproterenol, isoprenalin- agonis 2 selektif
2. DERIVAT XANTIN- teofilin
3. ANTIKHOLINERGIK- atropin- ipatropium bromid
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Agonis adrenergik 2 selektif
• Terbutalin (Allupent)• Albuterol (Salbutamol)• Metaproterenol efektif pd • Fenoterol serangan akut• Formoterol (-15jam)• Salmetrol (-15jam)• Selektivitas pada reseptor adr.2 • Efektif pd pemberian -p.o.
-aerosol onset cepat langs.reseptor
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Efek samping• -selektivitas terbatas• -aritmia ok stimulasi 1 jantung• -tremor, musc.cramps• -gangguan metabolisme• -iritasi pada penggunaan inhaler• -penggunaan lama reseptor desensitif
tolerans
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DERIVAT XANTINMETYLXANTIN TEOFILLIN
TEOBROMINCAFFEIN
EFEK - Relaksasi otot polos bronkhus- Stimulasi SSP- Stimulasi otot jantung- Diuresis- Asam lambung - Otot bergaris
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FARMAKOKINETIK
- absorpsi baik : - p.o., “sustained release” kadar stabil di plasma
- p.e. iv- distribusi : slrh tubuh plasenta, ASI - metabolisme : hepar
ok -induksi enz o/ rifampin, fenobarbtal, etanol
-rokok ok -inhibisi enz o/ simetidin, eritromisin, alopurinol
-gagal jantung, liver dis. -orang tua
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EFEK SAMPING
-iv.cepat aritmia jantung, hipotensi-Sakit kepala, palpitasi, dizziness, nausea,
hipotensi, nyeri prekordial -Indeks terapi sempit (10-20 g/ml) toksik konsentrasi plasma > 20 g/ml
takikardia, agitasi kejang, emesis, Gx.GIT-Anak-2 mudah kejang
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ANTIKHOLINERGIK
*ATROPIN : iv; aerosol*IPATROPIUM BROMID : aerosolMekanisme :
-Antagonis res.kholinergik M# otot polos bronkhodilatasi# kelenjar mukus
Efek sistemik :-Mulut kering, retensi urin, mata kabur, takikardi
Efektif u/ hiperreaktif bronkhokonstriksiCOPD, bronkhitis kronis,orang tua
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ANTIINFLAMASI
KORTIKOSTEROID reseptor steroid menghmbt mediator
EFEKMetabolisme : glukoneogenesis lipolisis & lipogenesis,fat deposisi katabolisme protein osteoforosis Imunosupresif: respon imun , limfosit Anti inflamasi: distribusi & fungsi leukosit, IL2, IL3 , mRNA COX2 Efek lain : dosis besar di SSP mempengaruhi mood, behavior stim.sekresi as.lambung (iritasi) retensi Na & H2O udema
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KORTIKOSTEROID PD ASMA BRONKHIALE
EFEK :-langsung otot polos bronkus (-)-inflamasi -hiperreaktivitas-efek pd reseptor adr. : afinitas
densitas Obat : prednison, prednisolon p.o mild asma : inhaler
triamcinolon, beclomethasone, triamcinolon, beclomethasone, budesonide, fluticasonebudesonide, fluticasone
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EFEK SAMPING
-lokal : kandidiasis, iritasi-sistemik : supresi adrenal
retensi Na dan air osteophorosis ulkus peptikum metab. KH “moon face”, “buffalo hump”
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KROMOLIN
per inhalasi-stabilisasi mast cell degranulasi (-)-efek samping : Batuk, edem laryng, nyeri sendi,
sakit kepala, rash, nausea-indikasi :
- preventif serangan asma
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Leukotriene pathway inhibitors Leukotriene pathway inhibitors (orally active)(orally active)
1.1. Zileuton: 5-lipoxygenase inhibitorZileuton: 5-lipoxygenase inhibitor
2.2. Zafirlukast and montelukast : LTDZafirlukast and montelukast : LTD44--
receptor antagonistreceptor antagonist
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Treatment• Correct hypoxia : Oxygen• reverse bronchospasm : bronchodilators
– nonspecific agonists– Beta 2 specific agonists
• inhaled short• inhaled long
– methylxanthines– anticholinergics
• treat inflammatory changes– anti-inflammatory– leukotrine antagonists- accolate, zyflo– mast cell membrane stabilizer- cromolyn (Intal)