CLINICAL PHARMACOLOGY &

DRUG PRESCRIPTION

DIKLAT RUANG TBMM NURUL QOLBI

JEANNY DWI ADRIYANTI, DR

DRUGS

FARMAKOKINETIK
FARMAKOKINETIK

FARMAKODINAMIK
FARMAKODINAMIK
 Routes of Administration
Systemic

 Enteral
© Oral
© Mucous :Sublingual, buccal, nasal, vaginal, rectal
 Parenteral
© Injection : Intravenous(i.v), intramuscular(i.m),
subcutaneous (s.c), intraperitoneal (i.p), intra-arterial,
intrathecal
Topikal

© dermal, vaginal, rectal

© inhalation
The main routes of drug administration and elimination
 GIT
DRUGS
 Ulcus Pepticum

Menghambat prod HCl Melindungi Mukosa Antasida

Menghambat prod HCl • Mg(OH)2
• Al(OH)3

AH2 PPI Sucralfate PG Analog

• Cimetidine • Omeprazole • misoprostol
• Ranitidine • Lansoprazole
• Famotidine
• Nizatidine
 Antikonstipasi
Laxative

Bulk forming Surfactants Stimulants/ Irritant Osmotics

• Psyllium • Docusate salts • Bisacodyl • Mg(OH2)
• Polycarbophil • Anthraquinone • Lactulose
• Methylcellulose • Danthron
• Mak berserat • Sodium
picosulfat
 Antidiare
Opiate-like Antidiarrheal Stool Modifiers
Agent • Kaolin
• Paregoric/ opium tincture • Wheat brand
• Diphenoxylate
• Difenoxin
• Loperamide
• codeine

Antiemetic
5HT3 Antagonist DA Antagonist Antikolinergik Cannabinoids
• Ondansetron
• Granisetron Phenothiazines Tetrahydrocannabino
• Prochlorperazine l
• Promethazine • Dronabinol
• Nabilone
Butyrophenones
• Haloperidol
• droperidol

Metoclopramide
RESPIRATORY DRUGS
 TERAPI ASMA
Ag (polutan, alergen)
hindariAg

Ag-Ab/IgE di mast cell

antiinflamasi, kromolin
MEDIATOR
bronkodilator antiinflamasi

Early response : Late response :

Bronchoconstriction Inflamation

Symptom Hyperreactivity
 Bronkodilator Obat Asma
2 antagonis/
mpatomimetik/ adrenergik
Anti
Glukokortikoid
inflamasi
• Metaproterenol (pot >>)
• Formoterol (durasi >>)
• Salmeterol/ Salbutamol Oral:
• Terbutaline • Prednisone
• Adrenalin/ Epinephrine • Betamethasone (pot, dur >>)
• Ephedrine
Inhalasi:
ntagonis muskarinik/ M3/ • Triamcinolone
ntikolinergik • Budesonide
• Fluticasone
• Ipratropium bromide • Beclomethasone
• Tiotropium bromide • flunisolide
• Atropine

Methylxantin Inhibitor degranulasi sel mast

• Theophylline
• Teobromine
• Sodium cromolyn (inh) Anti IgE:
• Caffeine • Omalizumab
 Obat Asma cont’nd...
3. Menghambat Kerja Mediator yg Dilepaskan sel Mast

Inhibitor Leukotrien AH1

Antagonis R/ Leukotrien (LT- Inhibitor Lipoxygenase

1) • Zileuton
• Zafirlukast
• Montelukast
 Obat Pilek (Dekongestan)
MK: agonis R/ α – vasokonstriksi – mukosa & sekresi - hidung longgar

Sistemik/ Oral Lokal/ Nasal

Spray: dewasa
Drops: < 6 th
• Pseudoephedrine
• PPA
• Phenylephrine • Ephedrine 0,25%
• Naphazoline HCl 0,05%
• Oxymetazoline 0,025. 0,05%
Gen 1 • Phenylephrine
• Diphenhydramine • Xylometazoline HCl 0,025. 0,1%
• Chlorpheniramine
• Promethazine
AH1 • Cyproheptadine
Gen 2
• Clemastine • Cetirizine
• Bisulepin • Loratadine MK: prod sekret
• Dimetinden • Terfenadin
• Azatadin • Astemizol
• Embramin
 Obat Batuk
1. Antitusif
MK: menekan refleks batuk

perifer central

• Uap menthol, miny. Opioid Non Opioid

Eucaliptus • Codeine • DMP (Dextromethorphan)
• Anestesi lokal topikal • Morphine
(benzocaine, lidocaine) • Hydrocodone
• Benzonatate
 Obat Batuk cont’nd
2. Ekspektoran
MK: mengencerkan sekret – merangsang pengeluaran sekret
• Guaifenesin (GG)
• Menthol & Camphor
• Ammonium Chloride
• Ipecac
• Potassium Iodide

3. Mukolitik
• N-Acetylcysteine
MK: menurunkan viskositas sekret dgn merusak ik. Disulfida
• DNA-ase (Pulmozyme)
MK: merusak DNA mukus scr enzimatik
OBAT ANTINYERI, ANTI-INFLAMASI,
ANTIPIRETIK
 MEKANISME NYERI
STIMULUS

KERUSAKAN JARINGAN

MEDIATOR NYERI
(HISTAMIN,PG,BRADIKININ,LEOKOTRIEN,SEROTONIN DLL)
analgesik non narkotik
NSAID Transduksi
RESEPTOR NYERI ( (nociceptor)
Antiinflamasi steroid

nestesi lokal Transmisi

SARAF SENSORIS
Modulasi
MEDULA SPINAL
Analgesik narkotik
Anestesi umum Persepsi

THALAMUS / KORTEKS PUSAT NYERI

Tx overdosis opioid
 Acetaminophen
Non Opioid
Tramadol COX-1
Inhibitor

COX-2
Inhibitor
• Celecoxib
• Rofecoxib
• Valdecoxib
 OBATANESTESI LOKAL

OBAT % DURASI MAX

Prokain, tetracaine, cocaine ester 2-4% 1½ jam 1000 mg

Lidokain 1-2% 1-2 jam 500 mg
Mepivacaine 1-2% 1-2 jam 500 mg
Prilokain amida 1-2% 1-2 jam 500mg
Bupivakain 0,5% 5-7 jam 200 mg
Ropivakain (Naropin) 2,5-7,5% 6-8 jam
(Levobupivakain) Chirokain
 Obat Migraine
severity last TTT

mild Migraine <2 hours analgesics (Aspirin,

Headache Acetaminophen , NSAIDS ) ,
Antiemetic
Moderate Migraine <4 hours refractory to above
Headache give Antiemetic , analgesics ,
5HT 1D agonist Triptan agents .
Severe Migraine 4-6 hours refractory to above
Headache give Other Antiemetic ,
Serotonin Agonist
Partial agonist α & 5HT (Dihydroergotamine , Triptans)
Severe Refractory 6 to 72 hours refractory to above
Migraine Headache Emergency ttt
status migrainosus over 72 hours
ANTI-GOUT
ANTIHIPERTENSI
 Penggolongan antiHT
CCB Nifedipine, verapamil, diltiazem

Vasodilator Oral Melepaskan NO: hydralazine

Membuka kanal K+: minoxidil

Parenteral Melepaskan NO: nitroprusside

Membuka kanal K+: diazoxide

ACEI Captopril, enalapril, quinapril, ramipril

Diuretik Thiazid: HCT (hydrochlorothiazide) chlorthalidone

Loop Diuretik: furosemide, torsemide, bumetanide

DHK+: amiloride, triamterene, spironolactone

ARB Irbesartan, losartan, valsartan

Simpatolitik CNS Aktivasi reseptor α2: clonidine,
agents guanabenz, guanfacine

Membentuk neurotransmiter
palsu: methyldopa
Ganglion
otonom Blok R/ Nikotinik: hexamethonium

Ujung Menghambat transpor NE ke vesikel

saraf sinaps: reserpine

Mengosongkan & memblok pelepasan

NE dari tmp penyimpanannya:
guanethidine

R/ Adrenergik α1 blocker: prazosin, oxazosin, terazosin

β1 blocker: atenolol, metoprolol
β blocker: propranolol
ANTIDIABETIK
 PRINSIP PENATALAKSANAAN DM
• Pengaturan diet
– Minum air banyak, susu skim dan minuman berkalori
rendah lainnya pada waktu makan
– Hindari makanan manis, gorengan, biskuit, cake
– Makanlah dengan waktu yang teratur
– Tingkatkan asupan sayuran dua kali tiap makan
– Jadikan nasi, roti, kentang, atau sereal sebagai menu utama
– Minum air atau minuman bebas gula setiap anda haus

• Latihan jasmani
Kegiatan jasmani sehari – hari dan latihan jasmani teratur, 3 –
4 x/mgg, selama ± 30 menit : jalan, bersepeda santai, jogging,
berenang. Latihan jasmani  me BB dan memperbaiki
sensitifitas thd insulin, serta me  uptake glukosa oleh otot
(tanpa perlu bantuan insulin)

• Farmakoterapi

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
 Mekanisme kerja
Oral Antidiabetics (OAD)

• Me  absorbsi glukosa : acarbose, biguanid

• Me  sekresi insulin (secretagogues) :
sulfonilurea 1st, 2nd , meglitinide
• Me  produksi glukosa hepar : biguanid
• Me  uptake glukosa di perifer :
sulfonilurea 2nd, biguanid, thiazolidindion

Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
ANTIBIOTIK
 Antibakteri• β laktam
Menghambat sintesis dinding sel
Merusak membran plasma
Menghambat sintesis protein
Menghambat sintesis as nukleat
(Penghambat Girase/ Kuinolon)
Menghambat sintesis metabolit
esensial
• Bacitracin (polipeptid siklik)
• Glikopeptid: vancomycin, teicoplanin
• Fosfomycin
• Polipeptida: tirosidin, gramisidin,
polymyxin, bacitracin
• Polien: nystatin, amphotericin B
• Aminoglikosida: 30S, 50S
• Tetrasiklin: tetracycline, oxytetracycline,
chlortetracycline, rolitetracycline,
demeclocycline, doxycycline, minocycline
• Linkosamid: clindamycin, lincomycin
• Makrolid: erythromycin, josamycin,
spiramycin, roxithromycin, Clarithromycin
• Sulfonamid: sulfacarbamid,
sulfamethoxazole, sulfalen, sulfasalazine
• Diaminobenzilpirimidin: trimethoprim,
tetroxoprim, pyrimethamine
 • Penisilin G (Benzilpenicillin Na/K)
• Penisilin depot: benzilpenicillin-procain,
benzilpenicillin-benzatin
• Penisilin oral: penicillin V (phenoxymetylpenicillin),
propycillin
• Penisilin oral stabil thp B-laktamase: oxacillin,
Penisilin dicloxacillin, flucoxacillin
• Penisilin spektrum luas: ampicillin, amoxicillin,
bacampicillin (ester sikarboniloksietil)
• Penisilin spek luas thp kuman gram (-) yg sulit
β laktam dibasmi: mezlocillin, piperacillin)
• Inhibitor B-laktamase: clavulenic acid, sulbactam,
tazobactam

Generasi 1: cefadroxil, cefazolin, cefalotin,

cefapirin, cefradin (Gr +)
Sefalosporin Generasi 2: cefamandole, cefumaxime,
cefuroksime, cefotiam (Gr -)
Generasi 3: cefotaxime, ceftriaxone (Gr -)
Generasi 4: cefepime (Gr +)
Karbapenem Imipenem, meropenem
Monobaktam Aztreonam
Aminoglikosida

• 30S: streptomycin, neomycin, gentaycin, kanamycin, amikacin, sisomycin,

tobramycin, spectinomycin
• 50S: (chloramphenicol, azidamphenicol, tiamphenicol), fusidic acid

Menghambat sintesis as nukleat

(Penghambat Girase/ Kuinolon)

• Generasi 1 (sal kemih): nalidicid acid, pipemidat acid, norfloxacin

• Generasi 2 (spek lebar): ofloxacin, ciprofloxacin
• Generasi 3 (gram + & atipikal): levofloxacin, grepafloxacin, sparfloxacin
• Generasi 4 (gram +, atipikal, anaerob): trovafloxacin, moxyfloxacin, clinafloxacin
 Antimikotik/ Antifungal
Membrane disrupting agents Amphotericin B, Nystatin

Ergosterol syn inh • Imidazol: clotrimazole, miconazole, ketoconazole

• Triazol: fluconazole, itraconazole
• Alilamin: naftifine
• Tiokarbamat: tolnaftate
• Morfolin: amorolphylline
Nucleic acid inh Flucytosine
Antimitotic (spindle disruption) Griseofulvin

Antiamoeba
Nitroimidazol Metronidazole, tinidazole

Antiviral
Acyclovir, valacyclovir, brivudine, famcyclovir,
Antiherpes
idoxuridine, gancyclovir, foscarnet, cidofovir
Antifungal
 dr. XXXXXXXX
S . P : 02.01.6.1.I.034x
S I P : 42x/MLG/DU/V/2002
Alamat Rumah : Jl. Melati no. X Malang Inscripti
Praktek : Jl. Rasuna Said 1 Malang . Telp : 348110 o
Jam : 17.00 – 19.00

Malang, 12 – 11 – 2007

R/ Methampyron ........................ 500 mg.

Diazepam ............................... 2 mg. Prescriptio
Coffein ................................... 20 mg.
Vit B1 ..................................... 50 mg.

Mf . la pulv . da in caps dtd . No . XII. Signatura

S 1 dd caps . I

P.P

Pro : Tn. Dody BB : Subscriptio

Alamat : ………… Umur :

43
Obat Luar
Pulveres
a
 K.I.E
 Pahami jenis obat yang di berikan
 Kenali latar belakang pasien
 Jelaskan ulang definisi dari penyakit sehingga pasien
paham dan tidak asal minum obat, (kecuali untuk
penyakit kronis)
 Pahami jenis penyakit beserta dietnya
 Motivasi pasien agar tidak hanya bergantung dengan
obat tapi juga harus menjaga gaya hidup sehat
 Motivasi pasien untuk rutin kontrol ke fasilitas
kesehatan terdekat terutama untuk penyakit kronis
dan penyakit dengan penanganan lebih lanjut