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FARMAKOLOGIMATA

OBATANTI GLAUKOMA

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OBATBERPENGARUHPADA
PENGLIHATAN

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Acne
Medication

Isotretinoin dry eyes and a sudden decrease

in night vision

Antihistamines CTM

Antimalaria

Narrow angle glaucoma

sudden vision changes,
headache pain around the eyes,
blurred vision, or double vision

chloroquine retinal toxicity, leading to

permanent vision loss

Corticosteroid prednison

cataract or glaucoma

Erectile
Dysfunction
Drugs

blurred vision, sensitivity to

light, and seeing a temporary
blue tinge

Ethambutol

sildenafil

visual acuity, or clarity, and

difficulty seeing certain colors

Phenothiazines chlorpromazine sensitivity to light, changes

in color vision, blurred
vision, and problems seeing
at night
Tamoxifen

crystalline retinopathy,
include blurred vision,
corneal changes, and an
increased risk for cataracts

Topiramate

Narrow angle glaucoma

sudden vision changes,
headache pain around the
eyes, blurred vision, or
double vision

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PUPIL
Ukuran pupil
dipengaruhi:
Cahaya
Parasimpatis
Simpatis

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MIDRIASIS
Cahaya redup++
Antimuskarinik++
Simpatomimetik+
Alfa1adrenoseptor
agonis+

MIOSIS
Cahaya terang++
Parasimpatomimetik++
Muskarinik agonis++
Stimulasi reseptor
opioid++
Alfa1-adrenoseptor
antagonis+

CATATAN:
Obat tetes mata dapat sebabkan efek samping
sistemik
Pigmen irisdapat menyerap obat (mis.Atropin)
Hitam >coklat >hijau >abuabu >biru
Onsetlambat,durasi memanjang

Beberapa obat dapat merubah warna mata

Epinefrin,latanoprost

Zat pengawet /tambahan pada tetes mata dapat

sebabkan alergi

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EFEKSAMPINGETAMBUTOL
1.neuritisretrobular
Butawarna merahhijau (etambutol 25mg/kg
selama beberapa bulan) Reversibel
penurunan ketajaman penglihatan
2. Otto-toksisitas (jarang), nervedeafness (biasanya
irreversible) pada terapi klorokuin dosis tinggi
jangka panjang
Tinitus dan berkurangnya pendengaran 500 mg
klorokuin 1x seminggu dalam beberapa bulan

EFEKSAMPINGKLOROKUIN
Kerusakanretinayangireversibel,penglihatan
kabur,kesulitanuntukmemfokuskan
pandangandanpenglihatanberkabut.
Gangguan penglihatan parah bisa terjadi jika
klorokuin digunakan jangka panjang dengan
dosis lebih dari 150mgperhari
Pengobatan jangka panjang dengan dosis tinggi
menyebabkan:keratopathy,transientedema

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ANESTESILOKAL

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LocalAnesthetics
Mekanismekerja:
memblokNachannelsecarareversibel
Berikatanpadareseptonditengahchannel

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2 Kelompok Anestesi Lokal:

dimetabolisme oleh
plasma cholinesterase
Amida dimetabolisme oleh
cytochrome p-450 di hati
Ester

Eliminasi/Metabolisme:

Esters

Plasma

Amides

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Tata nama: amida ada 2 i

Esters
Cocaine
Chloroprocaine
Procaine
Tetracaine

Amides
Bupivacaine
Lidocaine
Ropivacaine
Etidocaine
Mepivacaine

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ANESTESILOKAL
MATA

ANESTESI TOPIKAL

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ANESTESI TOPIKAL

ANESTESI TOPIKAL

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ANESTESI TOPIKAL

ANESTESI TOPIKAL

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ANESTESI SUNTIKAN

ANESTESI SUNTIKAN

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ANESTESI SUNTIKAN

ANESTESI SUNTIKAN

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ANESTESI SUNTIKAN

ANESTESI SUNTIKAN

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ANESTESI SUNTIKAN

Localanesthetic + vasoconstrictors
Adrenalin Vasokonstriksi hambat
aliran darah hambat metabolisme
Vasoconstrictors (adrenalin) tidak boleh
digunakan pada:
Jari
Hidung
Daun telinga
Penis

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Keamanananestesilokal
Related to
1) Drug
2) Dose
3) Site of administration
4) Condition of the patient
Efek SSP Efek Kardiovaskular
SSP:

Eksitasi depresi

All local anesthetics cross the blood brain

barrier
All local anesthetics cross the placenta and
enter the blood stream of the developing
fetus

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LocalAnestheticToxicity
Centralnervoussystem

LocalAnestheticToxicity
Cardiovascular
myocardial depression
vasodilation-- hypotension and
circulatory collapse
Allergic reactions-- rare (less than 1%)
preservatives or metabolites of
esters
rash, bronchospasm

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ANESTESILOKAL
TOKSISITAS
Faktor:
konsentrasi,carapemberian,BB
vaskularisasitempatpemberian,usia
rasakebaslidah+bibirtinnitus
tremor sakitkepala
drowsiness gangguankesadaran
kejang depresijantung&respirasi
Bupivacain langsungdepresijantung

PreventionandTreatmentofToxicity

Antisipasi terhadap kemungkinan

injeksi ke intravaskuler dan dosis
berlebih:
Selalu aspirasi saat memberikan suntikan
Waspada gejala keracunan SSP
Selalu lakukan monitoring
Sarana resusitasi
ABCs

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TreatmentofToxicity

Malignant Hyperthermia: pharmacogenic disorder in

which a genetic variant alters the persons response
to certain drugs.
Tachycardia, tachypnea (rapid breathing), unstable
blood pressure, cyanosis, fever muscle rigidity
and death;
68% mortality rate.

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ANESTESILOKAL
CARAPEMBERIAN:
directmucosal/skin
intradermal
infiltrasilokal
ringinfiltration
epidural/kaudal/extradural
spinal/subarachnoid
ivregionalanaesthesia(Biersblock)

ANESTESILOKAL
Lidokain
onsetcepat,durasi12jam
depresimyocardexcitability.terapiaritmia
Prilokain
durasi>lidokain,lesstoxic
banyakuntukdentalanestesi
Emlacream(lidokain+prilokain)
onset45menit anestesisempurna
Bupivacain
onsetlambat(30mnt),durasi24jam
epiduralanalgesi(persalinan)
lebihtoxic kontraindikasiiv

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ANESTESILOKAL
Ropivacain
durasi<bupivacain,lesstoxic
pengaruhmotorik<bupivacain
Levobupivacainlesstoxic
Tetracain(amethocain)
slowonset,longduration
sangattoxicperinj./mukosa
banyakuntukanestesikonj.mata&gel
Prokain?

Infiltrasi/Local/FieldAnesthesia
Application of local subcutaneously to
anesthetize distal nerve endings
Uses:
Suturing, minor superficial surgery, line placement,
more extensive surgery with sedation

Advantages:
minimal equipment, technically easy, rapid onset

Disadvantages:
potential for toxicity if large field

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Peripheral nerveblock
Injecting local anesthetic near the course of a
named nerve
Uses:
Surgical procedures in the distribution of the
blocked nerve

Advantages:
relatively small dose of local anesthetic to cover
large area; rapid onset

Disadvantages:
technical complexity, neuropathy

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Anestesi Blokepidural
Injection of local anesthetic in to the epidural
space at any level of the spinal column
Uses:
Anesthesia/analgesia of the thorax,
abdomen, lower extremities
Advantages:
Controlled onset of blockade, long duration when
catheter is placed, post-operative analgesia.

Disadvantages:
Technically complex, toxicity, spinal headache

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