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PERIFER
Dr.Muhammad Yusuf,SpS
kolinergik
Antagonis Muskarinik : Atropin, skopolamin,
Obat adrenergik : Epinefrin,Dopamin
Penghambat Adrenergik: Bloker, Bloker
Muscle Relaksan: Baklofen, Tizanidin,
Esperison, Toksin botulinum
Neurotropik : Mecobalamin
Atropin
MECHANISM OF ACTION
INDICATIONS
CONTRAINDICATIONS
ADVERSE REACTIONS
DOSE/ROUTE, ADULT,
Dopamine
Dopamine --catecholamine formed by the
decarboxylation of 3,4-dihydroxyphenylalanine
(DOPA).
central nervous system, especially in the
nigrostriatal tract, and in a few peripheral
sympathetic nerves.
Dopamine menghasilkan efek chronotropic
positif dan inotropik di jantung (myocardium),
hasilnya meningkatkan denyut jantung (heart
rate) and dan kontraksi jantung (cardiac
contractility).
Dosage
I.V. infusion (administration requires the use of an
infusion pump):
Neonates: 1-20 mcg/kg/minute continuous
infusion, titrate to desired response.
Children: 1-20 mcg/kg/minute, maximum: 50
mcg/kg/minute continuous infusion, titrate to
desired response.
Adults: 1-5 mcg/kg/minute up to 20
mcg/kg/minute, titrate to desired response
(maximum: 50 mcg/kg/minute). Infusion may be
increased by 1-4 mcg/kg/minute at 10- to 30minute intervals until optimal response is
obtained.
If dosages >20-30 mcg/kg/minute are needed, a
more direct-acting pressor may be more beneficial
(ie, epinephrine, norepinephrine).
epinefrin
A sterile solution intended for subcutaneous
INDICATIONS
respiratory distress bronchospasme,allergic
cardiac arrest due to various causes, but it is not
SIDE EFFECTS
Transient and minor side effects of anxiety,
CONTRAINDICATIONS
Beta Blocker
Beta blockers may be used to treat abnormal
Diazepam (Valium)
Mechanism of action: enhance GABA
activity
Clinical effects: decreased resistance to
passive ROM; decreased hyperreflexia;
reduced painful spasms; sedation; reduced
anxiety
Dose: initial 2 mg/day, gradually increase
to maximum 60 mg/day
Diazepam (Valium)
contd
Pediatric dosing: 0.12-0.8 mg/kg/day
Adverse effects: sedation, weakness,
Baclofen (Lioresal)
Mechanism of action: GABAB agonist
Clinical effects: decreased resistance to
Dantrolene sodium
(Dantrium)
Mechanism of action: reduces calcium
Dantrolene sodium
(Dantrium) contd
Pediatric doses (age > 5 yrs): 0.5 mg/kg
Tizanidine (Zanaflex)
Clonidine (Catapres)
Mechanism of action: alpha-2 receptor
agonist
Clinical effects: reduced tone, spasm
frequency, and hyperreflexia
Doses: tizanidine initial 4 mg three times
daily increase to 36 mg/day; clonidine initial
0.1 mg twice daily increase to 2.4 mg/day
Tizanidine (Zanaflex)
Clonidine (Catapres)
Pediatric dose: tizanidine dose not
experience
Cannabinoids (Marinol, Cesamet): work in
multiple sclerosis; limited information on
other uses
Orphenadrine (Norflex): short acting
Gabapentin (Neurontin): possibly helpful in
spinal cord injury or multiple sclerosis
to acetylcholine
Inhibits acetlycholine from entering the
synaptic cleft
Toxin serves as a block at the
neuromuscular unction
Can be administered to a specific muscle
or group via local injection
Botox
Used in tx of pts with focal dystonia as found
Adverse Effects
Tx limited to a few muscles due to potential
Eperisone
Eperisone hydrochloride
antispasmodic drug,
relaxing both skeletal muscles and vascular
Indications
In adults, the usual dose of eperisone is 50150 mg per day, in divided doses after meals.
Contraindications
Side effects
Mecobalamin
Indication & Dosage Oral
Peripheral neuropathies
Adult: 1500 mcg/day in 3 divided doses.
Parenteral
Peripheral neuropathies
Adult: 500 mcg daily IM/IV 3 times/wk.
Parenteral
Megaloblastic anaemia caused by vitamin
B12 deficiency
Adult: 500 mcg daily IM/IV 3 times/wk.
Maintenance dose: After about 2 mth of therapy,
reduce dose to single admin of 500 mcg every 1-3
mth.
Mechanisme of action
Mecobalamin is the neurologically active