8. farmakologi - dr. hanny nayoan - farmakologi obt yg dgunakan pd telinga

8/2/2019 8. Farmakologi - Dr. Hanny Nayoan - Farmakologi Obt Yg Dgunakan Pd Telinga

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1J.A.Najoan.dr.MKes.SpFK.


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Ototoksik

Mhs dapat mengetahui adalah obat-obat/gol obat yang dapat menyebabkan

gangguan pada fungsipendengaran/alat pendengar

Mhs dapat membedakan obat-obat/gol

obat yang menyebabkan ototosik



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It's Up To You

If you are like most people, you never give drugs asecond thought. Your doctor prescribes themyoutake them. It never enters your head that thesedrugs may be damaging your ears.

Manyhealth care professionals know little ornothing about ototoxic drugs and theirpronounced effects on hard-of-hearing people.Therefore, it is up to you to do all you can toprotect your ears from the ravages of ototoxicdrugs and chemicals.



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Ototoxic DrugsWhat Are They?

Ototoxic (OH-toe-TOKS-ik) drugs are thosemedications that can cause ototoxic (eardamaging) side effects to your ears.

Such drugs can cause hearing loss, hyperacusis(normal sounds now too loud), tinnitus and otherphantom sounds, and a whole host of balance

problems. This does not happen to everyone whotakes drugs by any means, but it does happen to asignificant number ofunfortunatepeople.



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Sudden Hearing Loss

Sudden Hearing Loss is a Medical Emergency:Recently I woke up and discovered I had lost the

hearing in my left ear while I slept. I went to mylocal doctor, but he didn't seem to think it was abig deal. He told me it was likely my ear pluggedup from a cold and to come back in a few days if itdidn't get better. I'm scared. Ten days have gone by,and I still can't hear out of my ear. What should Ido?



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Ketulian / Gangguan pendengaran

salah satu cacat tubuh yg banyak dijumpai

Insiden

Di Negara berkembang : 10% (dari jlh penduduk)

Survey DepKes di Jatim (1996) :

ganggauan pendengaran 16,8% ketulian 0,4%

Di Poli Audiologi : 29,38% (dari jlh kunjungan per tahun)

Penyebab a.l. : cacat bawaan, otitis media,

presbikusis, tuli mendadak, kecelakaan

atau trauma bising. (Palandeng.O.I)



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Berkurangnya Pendengaran & Tuli DEFINISI

Berkurangnya Pendengaran adalah penurunan fungsipendengaran pada salah satu ataupun kedua telinga.Tuli adalah penurunan fungsi pendengaran yang sangatberat.

PENYEBABPenurunan fungsi pendengaran bisa disebabkan oleh: Suatumasalah mekanis di dalam saluran telinga atau di dalamtelinga tengah yang menghalangi penghantaran suara

(penurunan fungsi pendengaran konduktif) Kerusakan padatelinga dalam, saraf pendengaran atau jalur sarafpendengaran di otak (penurunan fungsi pendengaransensorineural).


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Penurunan fungsi pendengaran sensorineuraldikelompokkan lagi menjadi:- Penurunan fungsi pendengaran sensorik (jika

kelainannya terletak pada telinga dalam)- Penurunan fungsi pendengaran neural (jika kelainannya

terletak pada saraf pendengaran atau jalur saraf

pendengaran di otak).

Penurunan fungsi pendengaran sensorik bisa merupakanpenyakit keturunan, tetapi mungkin juga disebabkan oleh:

- Trauma akustik(suara yang sangat keras)- Infeksi virus pada telinga dalam- Obat-obatan tertentu- PenyakitMeniere.


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KETULIAN AKIBAT BAHAN OTOTOKSIKA. Luar ( eksogen)

Obat obatanB. Dalam (endogen)

D.M

Penyakit Ginjal (Palandeng.O.I)



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Materi yang akan dibahas :

Ketulian akibat bahan ototoksik



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GAMBARAN KLINIK Ototoksik -- gangguan pendengaran. Tergantung:

dosis, waktu paruh obat, fungsi ginjal atau kondisidari stria vaskularis.

Keluhan : Tinitus, pendengaran menurun bilateral,vertigo (sering disertai muntah), gangguan

keseimbangan, oksilopsia.



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Kerusakan Telinga Akibat Obat-obatan

Beberapa obat, seperti:

- antibiotik tertentu

- diuretik (terutama asam etakrinat dan furosemid)- Aspirin dan zat-zat yang menyerupai Aspirin (salisilat)- kuinin bisa menyebabkan kerusakan pada telinga.

- Obat-obat tertentu menyebabkan gangguan pendengarandan keseimbangan, tetapi sebagian besar obat lebihbanyak menyebabkan gangguan pendengaran.



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Hampir seluruh obat tersebut dibuang dari tubuhmelalui ginjal.

Karena itu setiap kelainan fungsi ginjal akanmeningkatkan kemungkinanpenimbunan obatdi dalam darah dan mencapai kadar yang bisa

menyebabkan kerusakan.



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Dari semua jenis antibiotik, neomisinmemiliki efek yang paling berbahayaterhadap pendengaran, diikuti oleh

kanamisin dan amikasin.Viomisin, gentamisin dan tobramisin bisamempengaruhi pendengaran dankeseimbangan.



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Antibiotik streptomisin lebih banyakmempengaruhi keseimbangan.

Vertigo (perasaan berputar) dan gangguankeseimbangan akibat streptomisin cenderungbersifat sementara. Tetapi kadang bisa terjadisindroma Dandy, dimana gangguan keseimbanganbersifat menetap dan berat sehingga penderitamengalami kesulitan jika berjalan dalam ruangan

yang gelap.

Jika diberikan suntikan asam etakrinat dan

furosemid kepada penderita gagal ginjal yang jugamenjalani pengobatan dengan antibiotik, akanterjadi tuli permanen atau tuli sementara.



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Aspirin dalam dosis yang sangat tinggi yangdigunakan dalam jangka panjang bisamenyebabkan tuli dan tinnitus (telingaberdenging), yang biasanya bersifatsementara.

Kuinin bisa menyebabkan tuli permanen.

Jika terjadiperforasi gendang telinga, obat-obat yang bisa menyebabkan kerusakan

telinga tidak dioleskan/diteteskan langsungke dalam telinga karena bisa diserap kedalam cairan di telinga dalam.



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Antibiotik yang bisa menyebabkan gangguanpendengaran tidak diberikan kepada:- wanita hamil- usia lanjut- orang yang sebelumnya telah menderita ketulian.

Kepekaan setiap orang terhadap obat-obattersebut bervarisi, tetapi biasanya ketulian bisadihindari jika kadar obat dalam darah beradadalam kisaran yang dianjurkan.

Karena itu biasanya dilakukan pemantauanterhadap kadar obat dalam darah. Jikamemungkinkan, sebelum dan selama menjalanipengobatan dilakukan tes pendengaran.



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Biasanya tanda awal dari kerusakanadalah ketidakmampuan untukmendengarkan suara dengan nada

tinggi.Bisa terjadi tinnitus (telingaberdenging) atau vertigo.



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For example, one man who had taken Diazepamfor 8 years for anxiety, got obnoxious tinnitus just 4

days after discontinuing Diazepam. His tinnituspersisted for 3 months. Fortunately, after 6months, his tinnitus was only occasional and ofshort duration, and by 1 year it had completelydisappeared.

Another man began to hear high-pitched ringingtinnitus in both his ears for the first time in his lifeas he reduced his Diazepam dose to a low level.Unfortunately, in his case, he still had tinnitus 1

year later but was learning to cope with it.



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For example, Joan takes Celecoxib for herarthritis. When she takes it, her tinnitus gets

louder, but her arthritis pain improves. Shechooses the increased tinnitus (which doesntreally bother her) over the arthritis pain (whichshe definitely doesnt like). That is her choice, andshe is content to live with it.

Harold, on the other hand, began takingAmitriptyline and soon noticed he had severetinnitus. His tinnitus was driving him buggy sohe contacted me for help. I suggested the

Amitriptyline might be causing his tinnitus. Withhis doctors permission, he stopped taking thedrug. Twelve days later, he joyfully reported thathis tinnitus went away. That was his choice and heis glad he made it.



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Drug Interactions and EarsLittle is known about how ototoxic drugs adverselyaffect our ears. Dramatically less is known about

ototoxic side effectswhen two or more ototoxic drugsare consumed at the same time. However, someinteresting (and important) things have come to lightin recent years.



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The Order of Multiple Ototoxic Drugs Can BeImportant

Researchers have discovered that the order a person takes certainototoxic drugs can make an enormous difference as to whether theyhave much of a resulting hearing loss or not. With some drugcombinations, if you take the drugs sequentially, and notsimultaneously, you can avoid the synergistic effect.

For example, in one medical treatment, doctors put their patients ontwo drugs, a LOOP DIURETIC (e.g., Furosemide) and an

AMINOGLYCOSIDE antibiotic (e.g., Tobramycin). If the patientcompletes the course of the LOOP DIURETIC before he begins the

AMINOGLYCOSIDE antibiotic, the resulting hearing loss from thesetwo drugs is additive. However, if the patient takes both drugs

simultaneously or if the AMINOGLYCOSIDE antibiotic is administeredfirst, followed by the LOOP DIURETICthe two drugs actsynergistically to significantly damage the patient's ears.



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Some of the drugs that have this viciouseffect includeAspirin, the anti-cancerdrug Cisplatin, the microbial

antibiotic Chloramphenicol andAMINOGLYCOSIDE antibiotics suchas Gentamicin and Kanamycin.



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This same synergistic effect on hearing loss

between the ototoxic side effects of certain drugsand noise also occurs between certain chemicalsand noise.

Chemicals that make our ears more prone tohearing loss as a result of noise include organicsolvents such as carbon disulfide,

dinitrobenzene, styrene, trichloroethylene,toluene and xylene as well as the asphyxiantcarbon monoxide and the heavy metal lead.



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Other chemicalswith this same

nefarious characteristic includearsenic, butyl alcohol, butyl nitrite,heptane, hexane, manganese,

mercuryand trimethyltin. Thisapparently is just the tip of the iceberg.Suspicion is already cast on carbon

tetrachloride, various other metalsand asphyxiants.



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There are a number oforganic solvents.Some of them are benzene, benzylalcohol, butylalcohol, carbondisulfide,carbon tetrachloride, heptane, hexane,styrene, toluene, trichloroethylene andxylene. Ototoxic heavy metals includearsenic, cobalt, lead, manganese,

mercuryand trimethyltin.

J.A.Najoan.dr.MKes.SpFK. 26


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Learn the secrets of ototoxic drugs now.

You will be well-equipped to protectyourself from ear-damaging (ototoxic)drugs once you know the following:

Exactly what ototoxic drugs are.

24 symptoms of damage ototoxic drugs cando to your ears apart from hearing loss andhow this damage can adversely affect thequality of your life for years to come.

1



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19 drugs that have a severe risk of damaging yourears (and 96 that have a moderate risk). Ask your

doctor to substitute lower-risk drugs if at allpossible.

Details on 743 drugs, 30 herbs and 148 chemicals

that can damage your ears.

Find whatever drug you are looking for fast

whether you know the brand name or the genericname. 2,055 drug brand and generic names listed.

2



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Aminoglikosid

Efek AntimikrobaAminoglikosid ..gol antibiotika, bakterisidal ntoksikterhadap saraf otak VIII komponen vestibuler maupunakustik (ototoksik) dan terhadap ginjal (nefrotoksik)

Aktivitas dan mekanisme kerja- pada gram- negatif yang aerob (gentamisin,

tobramisin, kanamisin, netilmisin dan amikasin)

- aminoglikosid terikat riboson 30S dan menhambat

sintesis protein- neomisin, farmisetin dan paromomisin tidak

dianjurkan untuk sistemik



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Efak samping aminoglokosid1. Alergi

- Rash, eosinofilia, demam, diskrasiadarah, angioudema, dematitiseksfoliatif, stomatis dan syok

anafilaktik



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2. Reaksi iritasi dan toksikEfek toksik aminiglikosid pada sarafotak N.VIII mengenai komponen

vestibular dan akustik.

- Streptomisin dan gentamisin lebihmempengaruhivestbular

- Neomisin, kanamisin, amikasin dandihidrostreptomisin lebihmempengaruhi akuatik



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Oksitoksisitas aminoglikosid

dipengaruhi beberapa faktor :- besarnya dosis

- adanya gangguan faal ginjal

- usia tua- penggunaan oksitoksik lainya

- pemberian bersama asa etakrinat (diureti kuat)

- terapi berkepanjangan- demam



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Gangguan vestibular Gejala dini ialah sakit kepala, pusing, mual, muntah

dan gangguan keseimbangan

Tidak ada terapi khusus

Pemulihan dengan waktu 12 18 bulan pada beberappasien bisa menetap

Kerusakan pada nukleus kohliaris ventral dibtg otak

meluas ke ujung saraf di kohlea



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Gangguan akustik Tidak selalu pada kedua telinga

Gangguan gel frekwnsi tinggi berkurang

Secara klinis sebagai tuli saraf Tinitus bernada tinggi samapi 2 minggu aminiglikosid

dihentikan

Kerusakan akustik terutama berupa degenerasi berat

sel rambut organ Corti dari basilaris sampai apeksJarang terjadi pada anak



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Pengobatan

Belum ada yang pasti

Obat kurang bermanfaatSebagian besar sembuh spontan

- Kortikosteroid- Vasodilator



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PENATALAKSANAAN

Obat ototosik dihentikan

Pemberian Dekstran intravenous

Kortikosteroid

8. farmakologi - dr. hanny nayoan - farmakologi obt yg dgunakan pd telinga

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