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Chenny , dr. Bagian Farmakologi Fakultas Kedokteran Universitas Wijaya Kusuma Surabaya
Pain
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
INTERNATIONAL ASSOCIATION FOR THE STUDY OF PAIN ( IASP )
LANGKAH LANGKAH MENGHADAPI NYERI 1. 2. 3. 4. TENTUKAN MACAM NYERI DURASINYA ( AKUT / KRONIK ) INTENSITASNYA PENYEBABNYA
MACAM NYERI
NYERI
N. NOSISEPTIK
N. PSIKOGENIK
N. NEUROPATIK
INTENSITAS NYERI
MENGUKUR NYERI.? 1. NUMERIC PAIN INTENSITY SCALE (NPIS)
1-3 NYERI RINGAN
4-6
7 - 10
NYERI SEDANG
NYERI BERAT
TERMINOLOGI
AINS NSAID SAARD : Anti Inflamasi Non Steroid : Non Steroidal Anti Inflammation Drug : Slow Acting Anti Rheumatic Drug
DMARD
Analgesik Antipiretik
ANALGESIK
Opioid Analgesik
Non-Opioid Analgesik
Analgesik Antipiretik
AINS
Obat Pirai/Gout
Bradikinin
Leukotrien Histamin Serotonin
+++
++ +/-
+++ -
+++
-
Eicosanoid
Klasifikasi Prostaglandin, Prostasiklin, Tromboksan, Leukotrien Mekanisme Kerja Aktifasi reseptor Protein G menghambat Adenylyl Cyclase (c AMP) / Phosphatidylinositol cascade ( IP3 & DAG)
Prostaglandin
Prostaglandin E2 (PGE2) Prostasiklin (PGI2) Prostaglandin E1 (PGE1) Prostaglandin H2 (PGH2) Prostaglandin D2 (PGD2) Prostaglandin F (PGF) Prostaglandin G2 (PGG2)
* Eritema * Vasodilatasi * Peningkatan aliran darah lokal * Demam * Nyeri
Penggunaan Klinis
Obgyn PGE2 (Dinoprostone), PGF2, mematangkan Cervix, PGE1 (Misoprostol) Kontraksi uterus
Antagonis Eicosanoid
Kortiko steroid AINS Antagonis Leukotrien Zileuton Lypoxygenase inhibitor, Leukotrien receptor antagonist Zafirlukast, Montelukast
Ibuprofen - Advil Naproxen - Anaprox, Naprosyn Diclofenac - Voltaren Indomethacin Indocin Piroxicam - Feldene Metamizole - Novalgin Mefenamic Acid - Ponstan Ketorolac Tromethamine Toradol Ketoprofen - Profenid
Acetaminophen
Sejak 1893 Paracetamol Dipakai sebagai analgesik & antipiretik Tidak mempunyai efek anti inflamasi Menghambat PG di sentral Tidak mengiritasi lambung Do. besar (200-250 mg/kgBB) hepatotoksik Aman untuk Ibu hamil + menyusui Do. max : anak 60 90 mg/KgBB/hr dewasa 8 x 500 mg Antidot : Acetylcysteine i.v dalam larutan D5
AINS
Asam karboksilat Asam Enolat
Derivat Pirazolon
Fenilbutazon Oksifenbutazon
Derivat Oksikam
Piroksikam Tenoksikam
Asam Asetat
Der.As.Salisilat
Aspirin Benorilat Diflunisal Salsalat
Der.As.Propionat
Fenbufen Ibuprofen Ketoprofen Naproksen
Der.As.Fenamat
Asam mefenamat Meklofenamat
TOKSISITAS
Gastritis Tinnitus Prolonged Bleeding Time Allergy Reyes syndrome Aspirin
Pirai biasanya dikaitkan dengan kadar serum asam urat yang tinggi
Asam urat a zat sulit larut yang merupakan hasil akhir utama metabolisme purin
Purin
Hypoxanthine
Xanthine Oxydase
Xanthine
Xanthine Oxydase
Allopurinol
Tujuan pengobatan
Pengurangan intensitas serangan akut Mencegah kambuhnya episode pirai Mencegah timbulnya batu urat
Terapi simptomatis
Terapi kausatif
OBAT PIRAI
Akut
Kronis
AINS
Uricosuric Agent
Probenecid
Allopurinol
Uricosuric Agent
Mechanism compete with uric acid reabsorbtion in S2 segment of proximal tubule
Clinical Use treatment of chronic gout (after 1-2 week) Toxicity attack precipitation, allergenicity
Sulfasalazine
Antimalarial Anticancer
Rash, GIT, ototoxicity, myopathy, neuropathy Nausea, Ulcers, teratogenic Nephrotoxicity, hypertension, Peripheral neuropathy Upper respiratory infection Injection site reaction
Cyclosporine
Tissue Transplantation
Chrons Disease
Chelating Agent
Sulfasalazine
Unclear
Hydroxychloroquin, Penicillamine
Interfere T Lymphocyte activity Decrease leucocyte chemotaxis Stabilize lysosomal membrane Interfere DNA & RNA protein synthesis Trap free radical
Infliximab, Etanercept
Bind and prevent the action of TNF , a mediator in chronic inflamation