obat anti anemia
TRANSCRIPT
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Obat Anti Anemia
Dr.Ny.J.Tambajong-W, MS, SpFK
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• Proses penggantian sel2 darah scr kontinu Hematopoiesis
• Produksi sel baru sesuai kebutuhan • mis. Thdp anemia prod. Eritrosit 5x
Thdp inf. Sistemik prod leko thdp distruksi pltelet prod pltelet
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HenatinikObat yg digunakan utk m’obati anemia
• Obat2 yg digunakan utk eritropoiesis normal– Fe– Vit. B12– As. Folat– Riboflavin– Piridoksin– Co– Cu– H. Tiroid, gonad & adrenal– Eritropoieta (faktor p’tumbuhan sel drh merah yg di btk
terut di ren)
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1. Anti Anemia defisiensi
• Fe & garam2nyautk pbtkan Hb perlu FeDefic Fe anemia hipokronik mikrositik
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Protein
30% Fe non-esensial
70% Fe Esensial
cadanganhemostatic
Pd parenkim jaringan
feritin
transferin
enzim
myoglobin
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Kinetik
• Absorpsiabs mllui sal. Cerna, lbh mudah dlm btk ferokmd berubah jd feri msk plasma mjo feritin disimpal dlm selabs meningkat pd menstruasi & wanita hamilabs ditingkatkan oleh Co. Miosin, etionin, vit. C, HCl, suksinat
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Distribusi
• Stlh abs Fe diikat oleh transferin (siderofilin) ke jar, terut sutul & depot Fe. Diikat pula oleh sel2 retikulum
• Metabolisme– Fe + protein (apoferitin) Feritin disimpan dlm usus
halus & sel2 retikuloendotelial (di hepar, limfa, sutul). Nanti d’gunakan utk eritropoiesis.
– Bila diberi i.v cpt diikat oleh apoferitin disimpan di hepar
– Bila diberi oral terut disimpan di limfa & sutul
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Ekskresi
• Terut b’lgsg mllui sel epitel kulit & sal cerna yg t’kelupas; mllui keringat, urine, faeces kuku & rambut yg d’potong
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Kebutuhan Fe
• K’butugan tgtg:– Umur– Jenis kelamin– Jlh drh dlm badan (Hb)Cth :Pria :10mgWanita :12mgWanita hamil :+ 5mg
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Sumber
• Mknn kdr Fe tinggi (>5mg/100g):hati, jantung, kuning telur, ragi, kerang, kacang2an, buah2an kering
• Mknn kdr Fe sdg (1.5mg/100g):daging, ikan, unggas, sayur hijau, biji2an
• Mknn kdr Fe krg (<1mg/100g):sayur kurang hijau, susu
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• Indikasi– Pencegahan & pengobatan anemia– Mis. Kkrgn drh wanita hamil, masa p’tmbhan
• E.S– Oral : intoleransi• Gejala : mual nyeri imbg, kontisipasi, diare, kolik
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I.m/iv rx lokal t4 suntikan
• Rasa sakit, warna coklat t4 suntikan. Radang lokal, rx sistemik, mis. Nyeri otot & sendi, hemolisis, takikardia, flushing, keringat , mual muntah, bronkospasme, hipotensi, pusing, kolaps sirkulasi
• Stlh ½ jam – 24, bisa timbul : sinkope, demam, menggigil, rash, urtikaria, nyeri dada, sakit seluruh badan, ensefalopati, syok, henti jantung
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Bs trjd intoksikasi akut (lbh sering pd anak) timbul
• Terapi :– Usahakan muntah– Beri susu atau telur– A. Bila obat diminum < 1 jam : bilas lambung dengan
Bik Nat– B. Bila obat diminum > 1jam : tdk blh blas lmbng– Atasi syok dehidrasi– Diberi deferoksamin (chelating agent) spesifik utk Fe
Intoksikasi kronis meny hemosiderosis
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Sediaan
• Oral– Ferosulfat, fero glukonat, ferofumarat btk sitrat
karbonat, pirofosfat & feri skr larut• Parenteral– i.m & i.v bila p’berian oral tdk mgkn• Iron dextram• Iron sucrose• Iron sodium gluconate
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Vit. B12
• = Sianokobalamin
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Vit. B123
• Satu2nya klpk senyawa alam yg mgdg unsur Co
• Utk metab intrasel utk sintesis DNA– defisiensi meng. gguan produksi & materitas
eritrosit– anemia megaloblastik
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Defisiensi
• Ok :– Asupan krg– Abs tggu– Intabilitas tggu– Kebutuhan :• Destruksi blbhan• Ekskresi• Gguan fgs/struktur ileum• Peny. Pankreas• Infestasi parasit dlm usus
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Defisiensi d’tandai dgn
• Gguan hematopoiesis• Gguan neurologi• Kerusakan epitel• Dibilitas umum– Kebutuhan : rata2 1µg/hari– Sumber :
• Mikroorganisme• Mknn hewani jeroan & kerang• Kuning telur, sus kering bebas, lemak, & mknn dri ikan laut
(sardin, kepiting) jlh sedang
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Kinetik
• Absorpsi– Pd p’berian i.m & s.k abs baik & cepat– Per oral lambat
• Distribusi– Stlh abs, t’ikat prot ( ß glob ,α glikoprot, inter α
glikoprot)
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• Metabolisme :– Dlm hati kobalamin d’ubah mjd koenzim B 12
• Ekskresi:– Mllui urine (hny yg btk fak t’ikat)– 80-90% vit B12 diretensi dlm tubuh– Bit B12 bisa tembus sawar uri
• Indikasi:– Defis. Vit B12 mis Anemia pernisiosa
• Sediaan– Btk tablet & cairan utk suntikan– Cara p’berian t’baik adl i.m / s.k
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Asam Folat
• Tdd :– Bgn2 pteridin– As. Para amino benzoat (PABA)– As. glutamat
• Hpr semua jenis mknn t’dpt jenis as. Folat, kdr tinggi dlm hati, ragi
• Fgsi metabolik– Mrpkan prekursor inaktid bbrp koenzim utk transfer
unit karbon tggal• Kebutuhan 60µg/hari
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Defisiensi
• Sering mrpkan komplikasi dr gguan usus kecil, alkoholisme, efek toksis alkohol pd sel hepar & anemia hemolitik
• Obat2 yg mnghmbat dihidrofolat reduktase (trimetropin)
• Obat2 yg mgadakan interaksi pd abs & folat mis fenition, kontrasepsi oral
• anemia megaloblastik
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Gejala klinik• Hematopoiesis megaloblastik• Glikolisis• Diare• Penurunan bb• Insomnia• Polupa• Intabilitas
Kinetik : per oral abs baikDistribusi merata ke semua sel jaringan tjd penumpukan pd CSFEkskresi mllui ren
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Indikasi
• Pencegahan & p’obatan defisiensi folat utk diagnostik
• Sediaan :– Tablet 0.4, 0.8, & 1mg– Inj. 5mg/ml utk anti kanker– Sediaan kombinasi
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Riboflavin
• Sbg koenzim dlm metabolisme flavoprot• Dpt m’prbaiki anemia normokrom normositik• Dosis 10 mg/hari oral atau i.m
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Piridoksin (vit. B6)
• Mgkin bfg sb koenzim yg mrgsg pertumbuhan Heme
• Defis anemia mirostatik hipokronik
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Kobal
• Co dpt meningkatkan jlh hematokrit, Hb & eri• Co mrgsg pbtkn eritropoietin• Bisa tjd efek toksis
• Tembaga– Tdpt dlm sitokrom oksidase
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2. Eritropoietin
• St glikoprotein, mrpkn faktor pertumb hematopoietik yg 1x diisolasi
• St faktor pertumb sel darah merah yg diproduksi terut oleh ginjal
• F. Dinamik– E. Berinteraksi dgn res Eritropoietin pd perm. Sel induk
eri, mstimukasi proliferasi & diferensiasi eritroid– M’induksi p’lepasan retikulosit dr sutul– Kdr eritropoietin serum bkdg tbalik dgn kdr
hematokrit/Hb
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F. kinetik
• Pd p’berian i.v t1/2 pd gagal ginjal kronik 4-12jam
• Indikasi :– Utk anemia pd pasien gagal ginjal kronik
• E.S– Bertambah beratnya hipertensi– Penurunan Tendensi trombosis pd pasien dialisis
(?)
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Obat Antikoagulan, Antitrombotik, Trombolitik & Hemostatik
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Scr fisiologis fluiditas darah d’kendalikan darah ttp cair (dlm pblh darah)
• Darah m’beku perlukaan pmblh drh– Obat2 utk m’ubah keseimbangan antara
prokoagulan & antikoagulan• Hemostasis :– Adlh proses p’hentian prdrhan scr spontan pd
pmblh darah yg cedera– Yg berperan
• P.drh -> vasokonstriksi• Trombosit• Faktor pembekuan
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Antikoagulan
• Obat yg digunakan utk mencegah p’bekuan drh m’hmbat pbtkan/fgsi bbrp faktor p’bekuan drh
• m’cegah tbtk & meluasnya trombus & emboli– M’cegah pbekuan drh in vitro : lab & transfusi
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3 kelompok antikoagulan
• Parenteral– Heparin– Danaparoid– lepirudin
• Antikoagulan oral– Derivat 4 hidroksikumarin : dikumarol & walfarin– Derivat indan-1,3-dion: anlnsidion
• Antikoagulan yg bekerja mengikat ion Ca– Na – sitrat– As. Oksalat & senyawa oksalat– Na - edetat
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Heparin
• St mukopolisakarida yg mgdg sulfat• Disintesis dlm mas. Cell : byk t’dpt di paru
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F. dinamik
• Heparin b’ikatan dgn AT-IIIAT-III bfgsi menghambat protease faktor pbekuan mis. Faktor Ha (Trombin), Xa, Ixa, dgn cara mbtuk kompleks
• Heparin bsft lipotropik• Pd pmk darah– Tdk m’ubah hsl pmk rutin kimia darah– Mgubah btk eri & leko
• Mnekan kcptn sekresi aldosteron
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• Meningkatkan kdr tiroksin bekas pd plasma• Mnghambat aktivator fibrinolitik• Mnghmbat penyembuhan luka• Menekan imunitas seluler• Menekan rx hospes thdp graf & mpecepat
penyembuhan luka bakar
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F. kinetik
• Tidak diabs. Scr oral diberi secara s.k/i.v• T1/2 tgtg dosis– Scr s.k : bioavaibilitas bvariasi. Mula kerja lambat
& masa kerja lbh lama– Scr i.m : meny. Tjd hematom bsr pd t4 suntikan.
Abs tdk teratur– Scr i.v : efek tbl segera
• Ekskresi mllui urine• Tdk mllui plasenta & ASI
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E.S
• Prdrhn– Ringan stop obat– Berat protamin sulfat
• Rx hipersensitivitas : mggil, demam, urtikaria, syok anafilaksis
• Pgunaan lama :– mialgia, nyeri tl, osteoporosis– Alopesia, rasa panas di kaki– Trombositopenia ringan / berat– Nekrosis kulit (pd p’berian s.k)
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Indikasi
• Pcegahan & pengobatan trombosis vena * emboli paru
• Pengobatan awal pend. Angina tdk stabil atau infark miokard akut
• Pd angioplasti koroner/pemasangan stent• Selama operasi yg butuh by pass
kardiopulmoner• Pd pasien DIC tertentu• Wanita hamil yg perlu antikoagulan
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K.I
• Pend. Yg sdg alami pdrhn atau cenderung alami prdrhn, mis. Hemofilia, permeab kap meningkat, threatened abortion, prdrhn intrakranial, dll
• Selama & stlg op. Mata, otak & med spin, pasien yg alami pungsi lumbal atau anastesi blok
• Pend yg mndpt dosis bir etanol, premium alk & sensitif thdp heparin
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Antitrombotik• Adlh obat yg dpt mghambat agregasi trombosit p’btkan
trombus t’hambat• Obat2 yg tgolong antitrombotik :
– Aspirin– Diplridamol– Tiklopidin– Klopidogret– B-blocker– Glikoprotein IIb.IIIa
• Tiroflban• Abslksimad• epitifibatid
– Inhibitor
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Aspirin
• Mnghambat enzim siklooksigenase scr irreversible mnghmbt sintesis tromboksan A2
• Indikasi– Miokard infark mncegah kekambuhan– TIA/stroke
• E.S : mual, rasa tdk enak diperut. Prdrhn sal. cerna
• Dosis : 80-320mg/hari
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Trombolitik
• Melarutkan trombus yg sdh tbtk• Indikasi :– Miokard Infark– Trombosis v. Dlm & emboli paru– Tromboemboli arteri– Mlarutkan bekuan darah pd katup jtg buatan &
kateter intra vena
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Obat2 yg tgolong trombolitik
• Streptokinase• Urokinase• Aktivator plasminogen• Rt-PA (recombinant human tissue-type plasminogen
activator)• E.S :– Prdrhn– Mual, muntah– Bradikardia & aritmia (pend. Miokard infark)– Rx hipersensitivitas
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Kontra Indikasi
• Pend. Prdrhn internal• Stroke baru• Hipertensi• Gguan hemostatik• Kehamilan• Operasi besar
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Streptokinase
• B’asal dr streptococcus ß hemolyticus• Mgaktivasi plasminogen dgn cara tdk lgsg
mbtk kompleks aktivator• Mrpkn protein asing bs meny. Rx alergi• Masa paruh bifasik• Cara p’berian i.v
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Hemostatik
• Zat atau obat yg digunakan utk mnghentikan prdrhan
• Hemostatis– Lokal– sistemik
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1. Hemostatik lokal
• Hemostatik serap :– Menghentikan prdrhan dgn pbtkan st bekuan atau
mberikan jala2 serat2 yg mpmudh pbekuan bila diletakkan lgsg pd pmukaan yg brdrh
• Indikasi– Atasi prdrhn dr p d kecil, mis. Kapiler– Cth :
• Spons gelatin• Oksifet• Busa firin insani
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Astringen mengendapkan prot drh prdrhn berhenti
• Cth:– Feriklorida– Nitras argenti– Asam tanat
• Koagulan :– Mpecepat perok protombin trombin– Mnggumpalkan fibrinogen– Cth :
• Aktivator protombin• trombin
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• Vasokonstriktor– Cth :• Epinefrin• Vasopresin
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2. Hemostatik sistemik
• Yg tgolong h. Sistemik :• Faktor antihemofilik (faktor VIII) &
cryoprecipitated anti hemofilia factor– Indikasi :• Utk atasi prdrhan pd pend hemofilia A• Peny. Von willebrand
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E.S• Cryoprec reaski hipersensitivitas• Hepatitis Vi• Anemia hemolitik• Hiperfibrinogenemia• Mggigil• Demam
• Kompleks faktor IX• Desmopressin• Fibrinogen• Vit. K• As. Aminokeproat• As. Traneksamat
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TERIMA KASIH
• PS. MAAF YAH KLO ADA SINGKATAN YG NDA JELAS, KARENA SAYA HANYA MENGETIK APA YANG BISA SAYA LIHAT PADA FOTOCOPYAN MATERINYA...