refrat opioid

8/20/2019 Refrat Opioid

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2/28

PERIODE 08 JANUARI – 27 FEBRUARI 2016

BAB I

PENDA !"!AN

A# "A$AR BE"A%AN&

Farmako o!" #$ra%a &ar" ka'a ()*+a+", -.armako+ / o#a' o!"a /

%'*&" " m* Pa&a m* a+3a 4armako o!" m$+5ak*- #$r#a!a" -$+!$'a.*a+ '$+'a+!

o#a' 3a+! m$ "-*'"/ %$ ara. %*m#$r %"4a' %"4a' 4"%"ka &a+ k"m"a9" 5ara m$ra5"k

$4$k 4"%"o o!" &a+ #"ok"m"a9" m$ka+"%m$ k$r a a#%or-%" &"%'r"#*%"

#"o'ra+4orma%" &a+ $k%kr$%" %$r'a -$+!!*+aa+ o#a' *+'*k '$ra-" &a+ '* *a+ a"+

D$9a%a "+" &"&$4"+"%"ka+ %$#a!a" %'*&" '$r"+'$!ra%" '$+'a+! %"4a' %"4a' k"m"a &a+

or!a+"%m$ ."&*- %$r'a %$!a a a%-$k "+'$rak%" m$r$ka A'a* I m* 3a+!

m$m-$ a ar" "+'$rak%" o#a' &$+!a+ or!a+"%m$ ."&*- O-"o"& a&a a. %$m*a :a'

#a"k %"+'$'"k a'a* +a'*ra 3a+! &a-a' #$r"ka'a+ &$+!a+ r$%$-'or mor4"+ O-"o"&

&"%$#*' *!a %$#a!a" a+ !$'"ka +arko'"ka3a+! %$r"+! &a am a+$%'.$%"a *+'*k

m$+!$+&a "ka+ +3$r" %aa' -$m#$&a.a+ &a+ +3$r" -a%5a -$m#$&a.a+ ;a a.a+

ka&a+! ka&a+! &"!*+aka+ *+'*k a+$%'.$%"a +arko'"k 'o'a -a&a -$m#$&a.a+ a+'*+!

Bar* %$ra'*% 'a.*+ 3a+! a * '$r&a-a' %$&"k"' o#a' o#a' 3a+! #$r!*+a

%$5ara '$ra-$*'"k '$'a-" morphine '$ a. &"k$+a *+'*k m$r$&aka+ ra%a %ak"' 3a+!

%a+!a' .$#a' &$+!+ $4"ka%" 3a+! '"+!!" K$+3a'aa++3a %"r W" "am o% $r

m$+3$#*' morphine %$#a!a" “God’s own medicine” (o#a' m" "k T*.a+, &a+

%am-a" %aa' "+"morphine '$'a- a. %$#a!a" -$m#a+&"+! %'a+&ar *+'*k o#a' o#a'

&$+!a+ k$r a a+a !$%"k 3a+! k*a' I%'" a. a'$ a ka o"& a am" &a+

%$m"%"+'$%"% &ar" o-"*m %"4a' 4armako o!"%+3a m"r"- &$+!a+ -$+!!a+'"

%"+'$%"%+3a %$#!a"ma+a #a.a+ #a.a+ 5am-*ra+ a"+ 3a+! m$mm-*+3a" $4$k

2


3/28

m$+3$r*-a" o-"*m &"%aka' o $. a+'a!o+"% r$%$-'or o-"o"& +o+%$ $k'"4 3a"'*

naloxone. D$4"+"%" "+" m$ "-*'" #$#$ra-a -$-'"&$ $+&o!$+ 3a+! &"%"+'$%"% o $.

%$ %$ %ara4 &a+ %$ %$ m$&* a a&r$+a &a+ #$r"+'$rak%" &$+!a+ r$%$-'or

r$%$-'or o-"o"& Morphine &"a+!!a- %$#a!a" -ro'"-$ a!o+"% o-"o"& (Ka':*+!

2002,

S*m#$r &ar" o-"*m #a.a+ m$+'a.+3a &a+ morphine 3a+! %a a. %a'*

*+%*r$ ak'"4+3a a&a a. a-"*+ #*+!a ma&a' o-"*m (opium poppy) 3a"'* -a-a>$r

%om+">$r*m U+%*r$ *+%*r &ar" '*m#*.a+ "+" '$ a. &"k$+a %$ ak r"#*a+ 'a.*+

3a+! a * &a+ 5a'a'a+ -$+!!*+aa++3a &"'$m*ka+ &a am &ok*m$+ ;$%"r k*+o

)*+a+" &a+ Roma9" S$r'*+$r %$ora+! a. " 4arma%" J$rma+ m$+!"%o a%" a ka "

ak'"4 m*r+" &ar" o-"*m -a&a 'a.*+ 180? @a "+" m$r*-aka+ -$r"%'"9a -$+'"+!

3a+! m$m*+!k"+ka+ *+'*k m$+&a-a'ka+ %$#*a. -o'$+%" k$k*a'a+ %'a+&ar *+'*k

-ro&*k%" a am" S$'$ a. m$+!* " #a.a+ 5am-*ra++3a -a&a &"r"+3a %$+&"r" &a+

#$#$ra-a '$ma++3a %$r'*+$r m$m#$r"ka+ +ama “morphine” *+'*k #a.a+

5am-*ra+ "'* #$r&a%ar +ama &$9a m"m-" )*+a+" ;or-.$*% (Ka':*+! 2002,

B# $!'!ANT* *a+ &ar" maka a. "+" a&a a. /

1 U+'*k m$+!$'a.*" '$+'a+! a+a !$'"k o-"o"&2 U+'*k m$+!$'a.*" m$ka+"%m$ k$r a o#a' a+a !$'"k o-"o"&? U+'*k m$+!$'a.*" -$+!!o o+!!a+ &a+ ma5am ma5am o#a' a+a !$'"k o-"o"&

U+'*k m$+!$'a.*" 'ok%"%"'a% &a+ $4$k $4$k 3a+! '"&ak &""+!"+ka+ &ar"

-$+!!*+aa+ a+a !$'"k o-"o"&U+'*k m$+!$'a.*" -$+!!*+aa+ k "+"% o#a' a+a !$'"k o-"o"&

6 U+'*k m$m$+*." '*!a% ma'a k* "a. Farmako o!" &a+ Tok%"ko o!"

?


4/28

BAB II

I(I

A# N)ERI N3$r" a&a a. %$+%a%" %*# $k'"4 ra%a '"&ak +3ama+ 3a+! #"a%a+3a #$rka"'a+

&$+!a+ k$r*%aka+ ar"+!a+ a5'*a &a+ -o'$+%"a N3$r" &a-a' #$r%"4a' -ro'$k'"4

3a"'* m$+3$#a#ka+ "+&">"&* m$+ a*. &ar" %'"m* *% 3a+! #$r#a.a3a a'a* '"&ak

m$ ak*ka+ 4*+!%" %$-$r'" -a&a ka%*% +3$r" kro+"% N3$r" &a-a' &"ra%aka+ a-a#" a

r$%$-'or +3$r" %-$%"4"k '$rka'">a%" (Cor9"+ 200 ,R$%$-'or +3$r" &"%$#*' +o"%"%$-'or 3a"'* * *+! %ara4 #$#a% 3a+!

m$r$%-o+ '$r.a&a- #$r#a!a" %'"m* *% '$rma%*k '$ka+a+ m$ka+"% &$4orma%"

%*.* 3a+! $k%'r$m &a+ #$r#a!a" :a' k"m"a Im-* % %ara4 &ar" r$%$-'or +3$r" aka+

&"%am-a"ka+ k$ SSP m$ a *" %$ %$ %ara4 %$+%or"% S$'$ a. #$ra&a &" m$&* a

%-"+a "% %$#a!"a+ #$%ar %$ra#*' +3$r" #$r%"+a-% &" +$*ro+ -a&a kor+* &or%a &ar"

%$!m$+ '$m-a' %$ra#*' +3$r" ma%*k Aka+ '$'a-" %$#a!"a+ %$ra#*' #$r a a+

k$a'a% a'a* k$#a9a. #$#$ra-a %$!m$+ &"m$&* a %-"+a "% %$#$ *m #$r%"+a-%

S$'$ a. m$+!ak'">a%" %$ &" m$&* a %-"+a "% "+4orma%" m$+!$+a" %'"m* *% +3$r"

o $. %a a. %a'* &ar" &*a ara% a%$+&$+ k$ o'ak 'rak'*% +$o%-"+o'a am*% a'a*

'rak'*% -a $o%-"+o'a am*% (Cor9"+ 200 ,Trak'*% +$o%-"+o'a am*% I+4orma%" 3a+! &"#a9a k$ %-"+a &a am %$ra#*'

A 3a+! m$+5$'*%ka+ -o'$+%"a ak%" &$+!a+ 5$-a' &"%a *rka+ +a"k &ar" m$&* a

%-"+a "% k$ o'ak m$ a *" %$ra#*' 'rak'*% +$o%-"+o'a am*% S$#a!"a+ &ar" %$ra#*'

'$r%$#*' #$rak."r &"%"%'$m ak'">a%" r$'"5* ar %$."+!!a m$9a%-a&aka+ "+&">"&*

'$r.a&a- '$r a&"+3a +3$r" '$'a-" %$#a!"a+ #$%ar %$ra#*' #$r a a+ k$'a am*% Dar"

'.a am*% %"+3a %"+3a &"k"r"m k$kor'$k% %oma'o%$+%or"k '$m-a' oka%" +3$r"

'$r oka "%a%" &$+!a+ #a"k S'"m* a%" kor'$k% &"-$r *ka+ *+'*k "+'$r-r$'a%" %"+3a+3$r" %$5ara %a&ar (Cor9"+ 200 ,

Trak'*% -a $o%-"+o'a amm*% I+4orma%" 3a+! &"#a9a k$ %-"+a &a am

%$ra#*' C 3a+! &"%a *rka+ %$5ara am#a' &a+ 3a+! &"#a9a &a am #$#$ra-a

%$ra#*' A &"%a *rka+ +a"k k$ o'ak m$ a *" %$ra#*' 'rak'*% -a $o%-"+o'a am*%

S$ra#*' "+" #$r a a+ k$&a$ra. r$'"k* $r #a'a+! o'ak &a+ k$&a$ra+ m$%$+%$a o+

3a+! &"%$#*' ar$a !r"%$a -$r"ak*$&*k'*% S$ra#*' -a $o%-"+o'a am*% 3a+!

#$r a a+ m$ a *" ar$a r$'"k* $r #$r a+ *' *+'*k m$+!ak'">a%" ."-o'a am*% &a+

%"%'$m "m#"5 %$."+!!a m$m-$+!ar*." ar$a 3a+! m$+!o+'ro $mo%" "+" Ar$a


5/28

!r"%$a -$r"ak*$&*k'*% a&a a. -*%a' "+'$!ra%" 3a+! -$+'"+! *+'*k +3$r" P$r%$-%"

+3$r" %a+!a' &"mo&"4"ka%" -a&a &a$ra. "+" N3$r" 3a+! &"#a9a &a am 'rak'*% -a $o%-"+o'a am*% '$r oka "%a%" &$+!a+ #*r*k &a+ #$r-$ra+ m$+3$#a#ka+

&"%'r$%% $mo%"o+a 3a+! #$rka"'a+ &$+!a+ +3$r" (Cor9"+ 200 ,

B# ANA"&E$I%A OPIOID

A+a !$'"k +arko'"k k"+" *!a &"%$#*' o-"o"&a (m"r"- o-"a', a&a a. o#a'

o#a' 3a+! &a3a k$r a+3a m$+"r* (m"m"5, o-"o"& $+&o!$+ &$+!a+

m$m-$r-a+ a+! ak'"4a%" &ar" r$%$-'or r$%$-'or o-"o"& (#"a%a+3a r$%$-'or, a'

:a' "+" #$k$r a '$r.a&a- r$%$-'or o-"o"& k.a% &" SSP ."+!!a -$r%$-%" +3$r" &a+

r$%-o+ $mo%"o+a '$r.a&a- +3$r" #$r*#a. (&"k*ra+!", Da3a k$r a+3a &"

a+'a!o+"r o $. a +a ok%o+ ;"+"ma a&a $+"& r$%$-'or 3a+! -$+!"ka'a+

-a&a+3am$+"m#* ka+ a+a !$%"a T*#*. &a+ m$+%"+'$%a :a' :a' o-"o"&a+3a

%$+&"r" 3ak+" :a' :a' $+&or-."+ 3a+! *!a #$k$r a m$ a *" r$%$-'or r$%$-'or

o-"o"& '$r%$#*' (T a3 2007,

P$-'"&a o-o"& $+&o!$+ A ka o"& o-o"& m$+"m#* ka+ a+a !$%"a m$ a *"

k$r a+3a &"&a$ra. o'ak 3a+! m$+!a+&*+! -$-'"&a 3a+! m$m" "k" %"4a'

4armaka o!" m$+3$r*-a" o-o"& I%'" a. *m*m 3a+! &$9a%a "+" &"!*+aka+ *+'*k

%$+3a9a $+&o!$+ '$r%$#*' a&a a. -$-'"&a o-o"& $+&o!$+ m$+!!a+'"ka+ "%'" a.

$+&or4"+ 3a+! &"!*+aka+ %$#$ *m+3a T$ a. &""&$+'"4"ka%" ? $+"% -$-'"&a o-o"&/

$+k$4a "+ $+&or4"+ &a+ &"+or4"+ P$-'"&a o-"o"& 3a+! &"&"%'r"#*%" -a "+! *a%

&a+ m$m" "k" ak'">"'a% a+a !$%"k a&a a. -$+'a-$-'"&a m$'"o+"+ $+k$4a "+ (m$'

$+k$4a "+, &a+ $*%"+ $+k$4a "+ ( $* $+k$4a "+, Sa a. %a'* a'a* k$&*a

-$+'a-$-'"&a '$r%$#*' '$r&a-a' &" &a am k$ ? -ro'$"+ -r$k*r%or *'ama/ -r$-ro

o-"om$ a+okor'"+ -r$-ro$+k$4a "+ (-ro $+k$4a "+ A, &a+ -r$-ro&"+or4"+

(-ro$+k$4a "+ B, Pr$k*r%or o-o"& $+&o!$+ '$r&a-a' -a&a &a$ra. &" o'ak 3a+! #$r-$ra+ &a am mo&* a%" +3$r" &a+ *!a &"'$m*ka+ &" m$&* a a&r$+a &a+

- $k%*% %ara4 &" *%*%

;o $k* -r$k*r%or o-"o"& $+&o!$+ &a-a' &" $-a%ka+ %$ ama %'r$% %$-$r'"

a&a+3a +3$r" a'a* a+'"%"-a%" +3$r" (Ga+"%9ar+a 2007,


6/28

Gam#ar 1 Ak%" O-"o"& $+&o!$+ &a+ $k%o!$+ '$r.a&a- r$%$-'or o-"o"&

E+&or4"+ (mor4"+ $+&o!$+, a&a a. k$ om-ok -o "-$-'"&a 3a+! '$r&a-a' &"

SSP &a+ &a-a' m$+"m#* ka+ $4$k 3a+! m$+3$r*-a" $4$k mor4"+ a' :a' "+"

&a-a' &"#$&aka+ a+'ara H $+&or4"+ &3+or4"+ &a+ $+k$4a "+ 3a+! m$+&*&*k"

r$%$-'or r$%$-'or #$r a"+a+ S$5ara k"m"a9" :a' :a' "+" #$rka"'a+ &$+!a+ .ormo+

.ormo+ ."-o4"%"% &a+ #$r&a3a m$+%'"m* a%" -$ $-a%a+ &ar" kor'"ko'ro-"+

(ACT@, *!a &ar" %oma'o'ro-"+ &a+ -ro a5'"+ S$#a "k+3a -$ $-a%a+ @ &a+

FS@ &".am#a' o $. :a' "+" $+&or4"+ -a&a .$9a+ #$rk.a%"a' m$+$ka+

-$r+a4a%a+ m$+*r*+ka+ %*.* '*#*. &a+ m$+"m#* ka+ k$'a!".a+ a!"-* a

#$r&a3a a+a !$'"k k*a' &a am ar'" '"&ak m$r*#a. -$r%$-%" +3$r" m$ a"+ka+

m$m-$r#a"k" -$+$r"maa++3a Ra+!%a+!a+ "%'r"k &ar" #a!"a+ #a!"a+ '$r'$+'*

o'ak m$+!ak"#a'ka+ -$+"+!ka'a+ ka&ar $+&or-."+ &a am SSP ;*+!k"+ .a "+"m$+ $ a%ka+ $4$k a+a !$%"a 3a+! '"m#* %$ ama $ $k'ro%'"m* a%" -a&a

ak*-*+k'*r a'a* -a&a %'r$%% m"%a +3a -a&a 5$&$ra .$#a' P$r"%'"9a $4$k - a5$#o

*!a &".*#*+!ka+ &$+!a+ $+&or-."+ (T a3 2007,

A&a ? $+"% *'ama r$%$-'or o-"o"& 3a"'* m* ( , &$ 'a ( , &a+ ka--a ( ,

K$'"!a $+"% r$%$-'or '$rma%*k -a&a $+"% r$%$-'or 3a+! #$r-a%a+!a+ &$+!a+

-ro'$"+ G &a+ m$m" "k" %*#'"-$/ m*1 m*2 &$ 'a1 &$ 'a2 ka--a 1 ka--a 2 &a+

ka--a ? Kar$+a %*a'* o-"o"& &a-a' #$r4*+!%" &$+!a+ -o'$+%" 3a+! #$r#$&a

6


7/28

%$#a!a" %*a'* a!o+"% a!o+"% -ar%"a a'a* a+'a!o+"% -a&a $#". &ar" %a'* $+"%

r$%$-'or a'a* %*#'"-$ r$%$-'or maka %$+3a9a 3a+! '$r!o o+! o-"o"& &a-a'

m$m" "k" $4$k 4arm+ako o!" 3a+! #$ra!am (Ga+"%9ar+a 2007,

Gam#ar 2 &a+ "!a+& r$%$-'or o-"o"&

Ta#$ 1 K$r a O-"o"& -a&a R$%$-'or O-"o"&

O*atReseptor

m* ( , &$ 'a ( , ka--a ( ,P$-'"&a o-"o"&

E+k$4a "+

H –$+&o4$r"+

&"+or4"+

A!o+"%

A!o+"%

A!o+"% $ma.

A!o+"%

A!o+"%

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Ko&$"+

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;$'a&o+

;$-$r"&"+

F$+'a+"

A!o+"% $ma.

A!o+"%

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A!o+"%

A!o+"% $ma.

A!o+"% $ma. A!o+"% $ma.

A!o+"% a+'a!o+"%

7


8/28

B*-r$+o4r"+

P$+'a:o%"+

Na #*4"+

A!o+"% -ar%"a

A+'a!o+"% a!o+"

% -ar%"a

A+'a!o+"%

A!o+"%

A!o+"%A+'a!o+"%

Na ok%o+ A+'a!o+"% A+'a!o+"% A+'a!o+"%(Ga+"%9ar+a 2007,

R$%$-'or m$m-$ra+'ara" $4$k a+a !$+"k m"r"- mor4"+ $*4or"a &$-r$%"

+a-a% m"o%"% #$rk*ra+!+3a mo'" "'a% %a *ra+ 5$r+a R$%$-'or &"&*!a

m$m-$ra+'a" a+a !$%"a %$-$r'" 3a+! &"'"m#* ka+ -$+'a:o%"+ %$&a%" %$r'a m"o%"%

&a+ &$-r$%" +a-a% 3a+! '"&ak %$k*a' a!o+"% S$ a"+ "'* &" %*%*+a+ %ara4 -*%a' *!a &"&a-a'ka+ r$%$-'or 3a+! %$ $k'"4 '$r.a&a- $+k$4a "+ &a+ r$%$-'or

($-%" o+, 3a+! %a+!a' %$ $k'"4 '$r.a&a- #$'a $+&or4"+ '$'a-" '"&ak m$m-*+3a"

a4"+"'a% '$r.a&a- $+k$4a "+ T$r&a-a' #*k'" #*k'" 3a+! m$+*+ *kka+ #a.9a

r$%$-'or m$m$!a+! -$ra+a+ &a am m$+"m#* ka+ &$-r$%" -$r+a-a%a+ 3a+!

&"'"m#* ka+ o-"o"& Dar" -$+$ "'"a+ -a&a '"k*% &"&a-a'ka+ #a.9a r$%$-'or

&".*#*+!ka+ &$+!a+ #$rk*ra+!+3a 4r$k*$+%" +a-a% %$&a+!ka+ r$%$-'or

&".*#*+!ka+ &$+!a+ #$rk*ra+!+3a '"&a >o *m$ R$%$-'or a&a 2 $+"% 3a"'*

r$%$-'or 1 3a+! .a+3a &"&a-a'ka+ &" SSP &a+ &".*#*+!ka+ &$+!a+ a+a !$%"a

%*-ra%-"+a -$+! $-a%a+ -ro ak'"+ ."-o'$rm"a &a+ ka'a $-%" %$&a+!ka+ r$%$-'or

2 &".*#*+!ka+ &$+!a+ -$+*r*+a+ '"&a >o *m$ &a+ #ra&"kar&"a A+a !$%"a 3a+!

#$r-$ra+ -a&a '"+!ka' %-"+a #$r"+'$rak%" &$+!a+ r$%-$'or &a+ (Ga+"%9ar+a

2007,

U+&a+! U+&a+! Narko'"ka D"k$#a+3aka+ N$!ara #$#$ra-a *+%*r &ar"

k$ om-ok o#a' "+" %$-$r'" -ro-ok%"4$+ -$+'a:o%"+ &a+ 'rama&o '"&ak '$rma%*k

&a am U+&a+! U+&a+! Narko'"ka kar$+a #a.a3a k$#"a%aa+ &a+ a&"k%"+3a

r"+!a+ %$ka " Nam*+ -$+!!*+aa++3a *+'*k a+!ka 9ak'* ama '"&ak &"a+ *rka+

S$ ak 'a.*+ 1 78 %$&"aa+ %$&"aa+ &$+!a+ ka+&*+!a+ -ro-ok%"4$+ &" a'a% 1? m!

&" +$!r" B$ a+&a &"ma%*kka+ O-"*+9$' (U+&a+! U+&a+! O-"a', (T a3 2002,

+# ,E%ANI(,E %ER'A OBA$ ANA"&E$I%A OPIOID

8


9/28

E+&or-."+ #$k$r a &$+!a+ a a+ m$+&*&*k" r$%$-'or r$%$-'or +3$r" &"

SSP ."+!!a -$ra%aa+ +3$r" &a-a' &"# ok"r K.a%"a' a+a !$'"k o-"o"&a #$r&a%arka+

k$mam-*a++3a *+'*k m$+&*&*k" %"%a %"%a r$%$-'or +3$r" 3a+! #$ *m &"'$m-a'"

$+&or-."+ T$'a-" #" a a+a !$'"ka '$r%$#*' &"!*+aka+ '$r*% m$+$r*%

-$m#$+'*ka+ r$%$-'or r$%$-'or #ar* &"%'"m* a%" &a+ -ro&*k%" $+&or-."+ &"* *+!

%ara4 o'ak &"r"+'a+!" Ak"#a'+3a '$r a&" a. k$#"a%aa+ &a+ k$'a!".a+ (T a3 2007,

Gam#ar ? ;$ka+"%m$ k$r a a+a !$'"ka o-"o"&

K$r*%aka+ ar"+!a+ m$+3$#a#ka+ -$ $-a%a+ :a' :a' k"m"a (m"%a +3a

#ra&"k"+"+ -ro%'a! a+&"+ $&$+o%"+ 'r"4o%4a' (ATP, -ro'o+, 3a+! m$+%'"m* a%"

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10/28

Ak'">"'a% +$*ro+ r$ a3 kor+* -o%'$r"or &"mo&* a%" o $. #$#$ra-ainput

inhibisi I+-*' "+" m$ "-*'" "+'$r+$*ro+ oka 3a+! m$ $-a%ka+ -$-'"&a o-"o"&

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%$r"+!ka " m$m$r *ka+ a+'"$m$'"k E4$k -a&a - $k%*% %ara4 &" *%*% 3a+! -a%'"

&a+ #"a%a+3a m$m#*'*.ka+ ak%a'"4 T$ra-" ko+'"+* &$+!a+ a+a !$%"k o-"o"&

m$+3$#a#ka+ 'o $ra+%" &a+ k$'$r!a+'*+!a+ -a&a -5a+&* Aka+ '$'a-" -a&a

-a%"$+ &$+!a+ -$+3ak"' '$rm"+a -$+"+!ka'a+ 3a+! '$'a- -a&a &o%"% mor4"+ '"&ak '$r a&" %$5ara o'oma'"% B" ama+a .a '$r%$#*' '$r a&" $#". m*+!k"+ &"%$#a#ka+

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&$-r$%" +a-a% 3a+! &"%$#a#ka+ o $. o#a' 3a! m$+3$r*-a" mor4"+ Na ok%o+ *!a

m$m-r$%"-"'a%" %"+&rom -*'*% o#a' (withdrawal syndrome , #" a %*&a. '$r a&"

k$'$r!a+'*+!a+ A+a !$%"a $ $k'roak*-*+'*r a+a !$%"a 3a+! &""+&*k%" o $.

10


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11


12/28

&ar"-a&a mor4"+ Do%"% k$5" &"amor4"+ $-"&*ra %$mak"+ #a+3ak &"!*+aka+

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&"#$r"ka+ %$5ara ora ma*-*+ %*# "+!*a %$%aa' %$#$ *m '"+&aka+ 3a+!

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m$m-*+3a" a9"'a+ k$r a am#a' T$'a-" m$r*-aka+ a+a !$%"k $4$k'"4 %$'$ a.

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2002,

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12


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Ko&$"+ (m$'" mor4"+, &"a#%or-%" #a"k %$5ara ora '$'a-" m$m-*+3a"

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K$'$r!a+'*+!a+ o#a' '"-$ o-"o"&a &"'a+&a" &$+!a+ %*a'* !$ a a -*'*%

o#a' 3a+! r$ a'">$ %-$%"4"k &a+ %"+&roma a#%'"+$+%"a T$r&a-a' #$#$ra-a

-$r#$&aa+ 4armako o!"% a+'ara ma5am ma5am o-"o"& '$r&a-a' -* a

-$r#$&aa+ -o'$+%" -$+3a a.!*+aa+ &a+ !$ a a -*'*% o#a'3a+! $ $k

Co+'o.+3a !$ a a -*'*% o#a' &ar" k$'$r!a+'*+!a+ -a&a a!o+"% k*a' 3a+!

&".*#*+!ka+ &$+!a+ 'a+&a 'a+&a &a+ !$ a a !$ a a -*'*% o#a' 3a+! $#".

.$#a' &ar"-a&a !$ a a -*'*% o#a' &ar" a!o+"% r"+!a+ %am-a" %$&a+!P$m#$r"a+ a+'a!o+"% o-"o"&a -a&a %$%$ora+! 3a+! m$m-*+3a"

k$'$r!a+'*+!a+ o-"o"& &""k*'" !$ a a !$ a -*'*% o#a' 3a+! 5$-a' '$'a-"

%a+!a' #$r#a.a3a K$5$+&$r*+!a+ k$5a+&*a+ -a&a a+'a!o+"% a!o+"% -ar%"a

o-"o"& Nam-ak $#". r"+!a+ &"%#a+&"+! &$+!a+ k$'$r!a+'*+!a+ -a&a o#a'

o#a' a!o+"% (Ka':*+! 2002,

1, To $ra+%" m$%k"-*+ -$rk$m#a+!a+ 'o $ra+%" &"m* a" &ar" -$m#$r"a+

&o%"% -$r'ama o-"o"& 'o $ra+%" %$5ara *m*m '"&ak %$5ara a+!%*+! #$rma+"4$%'a%" k "+"% ."+!!a %$'$ a. 2 ? m"+!!* -$m#$r"a+ 3a+! #$rka "

ka "-a&a &o%"% '$ra-" #"a%a To $ra+%" #$rk$m#a+! -a "+! #a"k -a&a %aa'

&o%"% #$%ar &"#$r"ka+ &$+!a+ "+'$r>a 9ak'* 3a+! -$+&$k &a+ $4$k

m"+"ma #" a &"#$r"ka+ &$+!a+ o#a' &o%"% k$5" &$+!a+ "+'$r>a -a+ a+!2, K$'$r!a+'*+!a+ 4"%"k -$rk$m#a+!a+ k$'$r!a+'*+!a+ a&a a. %$ a *

m$+3$r'a" 'o $ra+%" -a&a -$m#$r"a+ * a+! o-"o"& '"-$ m* K$!a!a a+

*+'*k m$m#$r"ka+ o#a' %$5ara ko+'"+3* m$+"m#* ka+ !$ a a -*'*% o#a'

3a+! karak'$r"%'"k a'a* %"+&roma a#%'"+$+%"a 3a+! m$r$4 $k%"ka+

22


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-a+'* a+ #$r $#".a+ $4$k 4armako o!"% ak*' o-"o& Ta+&a 'a+&a &a+

!$ a a !$ a a -*'*% o#a' '$rma%*k r"+or$ akr"ma%" m$+!*a-

k$&"+!"+a+ ."-$r>$+'" a%" ."-$r'$m"a m"&r"a%" +3$r" o'o' m*+'a.

&"ar$ k$5$ma%a+ &a+ -$ra%aa+ "+!"+ mara.

?, K$'$r!a+'*+!a+ -%"ko o!"% E*-.or"a '"&ak #$r$ak%" '$r.a&ao %'"m* *%

&a+ %$&a%" #"a%a+3a &"%$#a#ka+ o $. a+a !$%"5 o-"o"& '$r*'ama a-a#" a

-$m#$r"a+ &$+!a+ "+ $k%" "+'ra>$+a 5$+&$r*+! m$+"!ka'ka+ -$+!!*+aa+

3a+! #$r* a+! * a+! S$#a!a" 'am#a.a+ -$5a+&* m$+!a am" $4$k

a#&om$+ 3a+! m"r"- &$+!a+ or!a%m$ %$k%*a 3a+! k*a' Fa5'or 4ak'or "+"

m$r*-aka+ a a%a+ *'ama *+'*k k$5$+&r*+!a+ -$+3a a.!*+aa+ o-"o"& &a+

&"-$rk*a' a!" o $. -$rk$m#a+!a+ &ar" k$'$r!a+'*+!a+ 4"%"k kar$+a

-$maka" o#a' m$ra%"o+a "%a%"ka+ ko+'"+*"'a% -$+!!*+aa+ o#a' %$#a!a"

a a' -$+5$!a. !$ a a !$ a a a#%'"+$+%"a m"%a +3a *+'*k '$'a- &a-a'

$r&o%"% O-"o"&

D"a!+o%"% o>$r&o%"% o-"o"& m*+!k"+ %a+!a' %$&$r.a+a -a&a -$5a+&*

3a+! &"k$'a.*" "&$+'"'a%+3a a'a* aka+ m$+ a&" %a+!a' %* "' %$-$r'" -a&ak$a&aa+ %$ora+! -a%"$+ &"ma+a '"&ak &"k$'a.*" "+4orma%" a'ar #$ aka+!

k$."&*-a++3a %ama %$ka " %*+'"ka+ +a oQo+$ %$5ara " > 0 2 0 m! %$5ara

&rama'"% aka+ m$m-$r#a"k" k$a&aa+ koma ak"#a' o>$r&o%"% o-"o"& '$'a-"

'"&ak &"%$#a#ka+ o $. &$-r$%a+ SSP (Ka':*+! 2002,

5 Ko+'ra I+&"ka%" &a+ K$9a%-a&aa+ Da am T$ra-"

1, P$+!!*+aa+ a!o+"% m*r+" &$+!a+ a!o+"% -ar%"a $ma.

2, P$+!!*+aa+ -a&a -a%"$+ &$+!a+ 5$&$ra k$-a a?, P$+!!*+aa+ %$ ama k$.am" a+

, P$+!!*+aa+ -a&a -a%"$+ &$+!a+ !a+!!*a+ 4*+!%" -ar*

, P$+!!*+aa+ -a&a -a%"$+ &$+!a+ !a+!!*a+ 4*+!%" .a'" &a+ !"+ a

6, P$+!!*+aa+ -a&a -a%"$+ &$+!a+ -$+3ak"' $+&okr"+

(Ka':*+! 2002,

I+'$rak%" o#a' Kar$+a ora+! 3a+! %ak"' -ara. &"r*ma. %ak"' m*+!k"+

m$m$r *ka+ #$r#a!a" ma5am o#a' o#a' %$ a * a&a k$m*+!k"+a+ "+'$rak%" o#a'

2?


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%aa' a+a !$%"k o-"o"& &"#$r"ka+ Ta#$ &"#a9a. m$+&a4'arka+ #$#$ra-a &ar"

"+'$rak%" o#a' "+" &a+ a a%a+ a a%a+ *+'*k '"&ak m$+!kom#"+a%"ka+ o#a' 3a+!

'$ a. &"%$#*'ka+ &$+!a+ o-"o"& (Ka':*+! 2002,

Ta#$ ? I+'$rak%" "+'$rak%" o#a' o-"o"&Kelompok

Obat

Interaksi dengan opioid

Sedatif-

Hipnotika

Menigkatkan depresi sistem saraf pusat, khususnya

depresi nafasAntipsikosis

penenang

(transquilizer)

Meningkatkan sedasi. Efek beraga pada depresi

nafas. Penonjolan efek-efek kardiovaskuler(kerja

antimuskarinik dan penyekata α.Inhibitor MAO ontra indikasi terhadap semua analgesik opioid

karena tingginya insiden koma hiperpireksia,

hipertensi juga dilaporakan.(Ka':*+! 2002,

F#PEN&&!NAAN %"INI( ANA"&E$I%A OPIOID

1 A+a !$%"

N3$r" 3a+! -ara. &a+ '$r*% m$+$r*% (ko+%'a+, #"a%a+3a &a-a' &"a'a%"

&$+!a+ o-"o"& %$&a+!ka+ +3$r" 3a+! 'a am %$#$+'ar &a'"+! &a+ %$#$+'ar

." a+! ("+'$rm"'$+, 'am-ak+3a %*kar *+'*k &"." a+!ka %$#*a. -$r5o#aa+

.ar*% &" ak*ka+ *+'*k m$+!*a+'"4"ka%" +3$r"+3a .a%" +3a &"!*+aka+ *+'*k

m$m" ". a!$+ 3a+! '$-a' &a+ *+'*k m$mo+"'or $4$k+3a Da am $>a *a%" &a+

-ro%$% %$ $k%" "+" -$r'"m#a+!a+ #a!a"ma+a 5ara -$m#$r"a+ -$+!o#a'a+ (ora

a'a* -ar$+'$ra , ma%a k$r a $4$k '$r'"+!!" (mak%"ma , ama '$ra-"

-$+!a ama+ am-a* &$+!a+ o-"o"& %a+!a' a. -$+'"+! (Ka':*+! 2002,

N3$r" 3a+! &".*#*+!ka+ &$+!a+ ka+k$r &a+ -$+3ak"' '$rm"+a .ar*%

&"'$ra-" %$5ara a&$k*a' &a+ #$r.*#*+!a+ &$+!a+ 'o $ra+%" &a+

k$'$r!a+'*+!a+ .ar*% &"k$%am-"+!ka+ &a am *%a.a m$m#*a' -a%"$+ m$ra%a

%$+3ama+ m*+!k"+ R"%$' 3a+! &"a&aka+ o $. -$'*!a% RS &"#a!"a+ *+*"'

!a9a' &ar*ra' #a.9a "+'$r>a -$m#$r"a+ o-"o"& (m"%a +3a &o%"% r$!* ar

2


25/28

&a am 9ak'* 3a+! r$!* ar -* a, a&a a. $#". $4$k'"4 &a am m$+!a'a%" ra%a

+3$r" &"#a+&"+!ka+ -a&a &o%"% 3a+! #$r&a%arka+ %aa' &"#*'*.ka+ (o+

&$ma+&, B$+'*k &o%"% #ar*morphine 3a+! m$m*+!k"+ka+ r" "% 3a+! $#".

am#a' &ar" a ka o"&+3a ara+! '$r%$&"a (m"%a +3a ;S Co+'"+, K$*+'*+!a+

*'ama+3a a&a a. '"+!ka' a+$%'$%" 3a+! $#". ama &a+ $#". %'a#" J"ka a&a

!a+!!*a+ -a&a %a *ra+ 5$r+a m$+5$!a. -$+!!*+aa+ morphine r" "% am#a'

%"%'$m 'ra+%&$rma fentanyl (4$+'a+3 '$m-$ , &a-a' &"!*+aka+ &a am -$r"o&$

$#". ama 3a"'* m"+!!*a+ a'a* #* a+a+ $#". a*. a!" fentanyl

'ra+%&$rma &a-a' &"!*+aka+ *+'*k #$#$ra-a $-"%o&$ &ar"breakthrough pain

P$m#$r"a+ o-"o"& k*a' %$5ara "+%*4 a%" +a%a %*&a. '$r#*k'" am-*. &a+

-r$-ara' +a%a %$kara+! m* a "+" ma%". %$&a+! &a am -ro%$% O#a' o#a'a+

%'"m* a+' %$-$r'"amphetamine &a-a' m$+!a'a%" k$r a a+a !$%"5 &ar" o-"o"&

&a+ *+'*k "'* &a-a' %a+!a' #$r!*+a #a!" -$+&$r"'a &$+!a+ +3$r" kro+"%

A!o+"% a&r$+o%$-'or a 4a2 (m"%a +3aclonidine , '$ a. '$r#*k'" #a"k %$5ara

a#ora'or"*m ma*-*+ %'*&" k "+"% m$m-*+3a" $4$k a+a !$%"k #" a &"#$r"ka+

&a am #$r#a!a" ma5am 5ara -$m#$r"a+ '$'a-" '$m-a' #a!" o#a' o#a' "+"

&a am -$+!$ o aa+ -$+3$m#*.a+ +3$r" ma%". $ a% (Ka':*+! 2002,

2 E&$ma Par* Ak*'Ra%a $!a 3a+! &".a%" ka+ &$+!a+ -$m#$r"a+ mor-."+$ "+'$r>$+a -a&a

k$a&aa+ %$%ak kar$+a $&$ma -ar* 3a+! #$r.*#*+!a+ &$+!a+ k$!a!a a+

>$+'r"k$ k"r" %a+!a' a. *ar #"a%a ;$ka+"%m$ '$r%$#*' '"&ak $ a% '$'a-"

m*+!k"+ #$rka"'a+ &$+!a+ #$rk*ra++3a -"k"ra+ 5$ma% o $. kar$+a %$%ak

+a-a% &a+ ra%a !$ "%a. &a+ m$+*r*++3a kar&"ak -r$ oa& &a+ a4'$r oa&

(Ka':*+! 2002,

? Ba'*k S*-r$%" -$+$ka+a+ #a'*k &a-a' &" ak*ka+ &$+!a+ -$m#$r"a+ &o%"%

3a+! $#". r$+&a. &ar"-a&a &o%"% 3a+! &"-$r *ka+ *+'*k a+a !$%" Nam*+

-a&a 'a.*+ 'a.*+ '$rak."r "+" -$+!!*+aa+ a+a !$%"5 o-"o"& *+'*k m$ $!aka+

#a'*k %a+!a' %$&"k"' kar$+a %$ *m a. #$%ar %$+3a9a %"+'$%"% 3a+! $4$k'"4 3a+!

'"&ak m$+!a+&*+! $4$k a+a !$%"k a'a*-*+ a&"'"4 '$ a. &"k$m#a+!ka+ A!$+

a!$+ "+" &"#a.a% &" #a9a. -a&a #a!"a+ m$+!$+a" a+'"'*%"4 (Ka':*+! 2002,

D"ar$

2


26/28

D"ar$ &ar" .am-"r %$!a am ma5am -$+3$#a# &a-a' &"k$+&a "ka+

&$+!a+ a+a !$%"5 o-"o"& '$'a-" ka a* "'* #$r.*#*+!a+ &$+!a+ "+4$k%" maka

3a+! '$-a' D* * -$r-ara' #a.a+ &a%ar o-"*m (m"%a +3a paregoric , &"-aka"

*+'*k m$+!$+&a "ka+ &"ar$ '$'a-" %$kara+! -$+!!a+'" -$+!!a+'" %"+'$%"%

&$+!a+ $4$k $4$k !a%'ro"+'$%'"+a 3a+! $#". %$k$k'"4 &a+ %$&"k"' a'a* 'a+-a

$4$k $4$k %"%'$m %ara4 -*%a' '$ a. &"!*+aka+ %$-$r'"diphenoxylate.

"henylpiperidine 3a+! &"%$#*' &" #a9a. "+" &a+ %$5ara k.*%*% &"%"a-ka+

*+'*k '* *a+ "+" (Ka':*+! 2002,

A- "ka%" &a am A+$%'$%"

O-"o"& %$r"+!ka " &"-aka" %$#a!a" o#a' o#a' -ramm$&"ka%" %$#$ *m

a+$%'$%" &a+ -$m#$&a.a+ &" ak*ka+ kar$+a %"4a' %$&a'"4+3a a+'"5$ma% &a+

a+$ !$%"+3a O-"o"& *!a %$r"+! &"-aka" &a am o-$ra%" o $. kar$+a 2 a a%a+

3a"'* %a'* %$#a!a" 'am#a.a+ *+'*k a!$+ a!$+ a+a%'$%"k 3a+! a"+ &a+ k$&*a

&a am -$m#$r"a+ &o%"% 3a+! '"+!!" (m"%a +3a fentanyl , %a+!a' *m*m &a am

o-$ra%" kar&"o>a%k* $r &a+ $+"% $+"% #$&a. 3a+! %a+!a' #$r"%"ko '"+!!"

a"++3a &"maa+ %a%ara+ *'ama+3a a&a a. m$m"+"ma ka++ &$-r$%"

kar&"o>a%k* $r Da am %"'*a%" %"'*a%" &$m"k"a+ #a+'*a+ r$%-"ra%" m$ka+"%

.ar*% &"%"a-ka+ (Ka':*+! 2002,

26


27/28

BAB III

%E(I,P!"AN

K$%"m-* a+ 3a+! &a-a' &"am#" &ar" -$m#*a'a+ maka a. "+" a&a a. /

1 A+a !$'"k +arko'"k a&a a. o#a' o#a' 3a+! &a3a k$r a+3a m$+"r* o-"o"&

$+&o!$+ &$+!a+ m$m-$r-a+ a+! ak'"4a%" &ar" r$%$-'or r$%$-'or o-"o"&

2 K.a%"a' a+a !$'"k o-"o"&a #$r&a%arka+ k$mam-*a++3a *+'*k m$+&*&*k" %"%a

%"%a r$%$-'or +3$r" 3a+! #$ *m &"'$m-a'" $+&or-."+ E+&or-."+ #$k$r a

&$+!a+ a a+ m$+&*&*k" r$%$-'or r$%$-'or +3$r" &" SSP ."+!!a -$ra%aa+ +3$r"

&a-a' &"# ok"r

? O#a' a+a !$'" o-"o"& &"#a!" m$+ a&" #$#$ra-a !o o+!a+ 3a"'* a!o+"% k*a'

a!o+"% %$&a+! 5am-*ra+ a!o+"% a+'a!o+"% &a+ a+'a!o+"%

P$+!!*+aa+ a+a !$'"k o-"o"& a+'ara a"+ &"'$ra-ka+ -a&a '$ra-" a+a !$%"

$&$ma -ar* ak*' &"ar$ #a'*k &a+ a+$%'$%"

27


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DAF$AR P!($A%A

Cor9"+ E J 200 $uku %aku "atofisiologi P$+$r#"' B*k* K$&ok'$ra+ EGC

Jakar'a

Ga+"%9ar+a 2007 &armakologi dan 'erapi disi Ba a" P$+$r#"' FKUI Jakar'a

Ka':*+! B G ; D P. D 2002 &armakologi *asar dan +linik Sa $m#a;$&"ka Jakar'a

;35$k ; J 2001 ,ippincott’s -llustrated e#iews "harmacology / th dition"--"+5o'' Ra>$+ P*# "%.$r P." a&$ -."a

N$a ; J 2002 Medical "harmacology at a Glance / th dition T.$ B a5k9$P*# "%."+! Com-a+3 o+&o+

T a3 T @ Ra.ar& a K 20070bat10bat "enting Gram$&"a Jakar'a

refrat opioid

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