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    FARMAKOLOGIFARMAKOLOGI OBATOBAT PADAPADA REAKSIREAKSI

    HIPERSENSITIVITASHIPERSENSITIVITAS

    Noor Wijayahadi

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    Classii!a"io#Classii!a"io#

     Coombs and Gell classificationCoombs and Gell classification

    1-Type I - immediate ( atopic, or anaphylactic) 2-Type II - antibody-dependent sitotoksik

    anemi hemolitik

    3-Type III - immune comple serum sickness

    !-Type I" - cell-mediated or delayed 

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    Allergy

    Ig E mediated(Type I hypersensitivity)

    Non Ig E mediated

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    Tr$a"%$#" a&&roa!h$s or I'E(%$dia"$d All$r'y

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    T$ra&iT$ra&i

      ANTAGONIS KIMIAWI ANTAGONIS KIMIAWI

     ) ANTI HISTAMIN ANTI HISTAMIN

     ) STEROIDSTEROID

      ANTAGONIS F*NGSIONAL ANTAGONIS F*NGSIONAL

     ) Bro#+odila"orBro#+odila"or 

     adr$#ali#adr$#ali#

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    PENGELOLAAN S,OK ANAFILAKTIKPENGELOLAAN S,OK ANAFILAKTIK

     POSISI S,OKPOSISI S,OK

      ABC -Air.ay(Br$a"hi#'( Cir!/la"io#0 ABC -Air.ay(Br$a"hi#'( Cir!/la"io#0

     VASOKONSTRIKTORVASOKONSTRIKTOR  ADRENALIN ADRENALIN

     CEGAH REAKSI LAN1*TANCEGAH REAKSI LAN1*TAN  STEROIDSTEROID  S*PORTIF2S*PORTIF2

     ) CAIRANCAIRAN

     ) OKSIGENOKSIGEN

    NB2 MASA KER1A ALERGEN 3s OBATNB2 MASA KER1A ALERGEN 3s OBAT

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    CorticosteroidsCorticosteroids

    45 I%/#od$&r$sa#45 I%/#od$&r$sa#

    65 A#"i(i#la%asi65 A#"i(i#la%asi

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    #entuk $ediaan#entuk $ediaan

     GlucocorticoidsGlucocorticoids $hort actin%$hort actin%

    Intermediate actin%Intermediate actin%

    &on% actin%&on% actin%

     'ineralocorticoids'ineralocorticoids

     Inhalant steroidsInhalant steroids

     Topical steroidsTopical steroids

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    harmacokineticsharmacokinetics

     bsorptionbsorption** all areall are rapidly + completelyrapidly + completely absorbedabsorbed

     TransportTransport**   Transcortin .Transcortin .

     lbumin .lbumin .

     /ree form 20./ree form 20.

     'etabolism'etabolism** 

     by lier enymes, conu%ation + ecretion by urineby lier enymes, conu%ation + ecretion by urine  partly ecreted as 1-ketosteroids4partly ecreted as 1-ketosteroids4

     tt152152 of cortisol 14 hoursof cortisol 14 hours

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    $hort ctin% Glucocorticoid (t152 6 12 h)$hort ctin% Glucocorticoid (t152 6 12 h)

    7ru%7ru% nti-inflam4nti-inflam4 $alt retainin%$alt retainin% reapartions + dosereapartions + dose

    CortisolCortisol 11 140140     m% tablet m% tablet

     100 m%5ial (i4m4, i4)100 m%5ial (i4m4, i4)  Topical8 enemaTopical8 enema

    CortisoneCortisone 049049 049049     m% tablet m% tablet

     2 m%5ial (i4m)2 m%5ial (i4m)

    Intermediate ctin% GlucocorticoidIntermediate ctin% Glucocorticoid (t(t152152 : 12 -3; h): 12 -3; h)

    rednisonerednisone !! 049049 ((

    rednisolonerednisolone  043043    , 10 m% tablet, 10 m% tablet

     20 m%5ial (i4m, intrarti)20 m%5ial (i4m, intrarti)

    'ethyl'ethyl

    prednisoloneprednisolone

     00    04, 140 %m in4 for i4m404, 140 %m in4 for i4m4

    or slo< i44or slo< i44

    TriamcinoloneTriamcinolone  00    ! m% Tab4,! m% Tab4,

     10, !0 m%5ml for i4m4 +10, !0 m%5ml for i4m4 +

    intrarticular in4intrarticular in4

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    7ru%7ru% nti-nti- inflam4inflam4

    $alt retainin%$alt retainin% reapartions + dosereapartions + dose

    &on% ctin%&on% ctin% GlucocorticoidGlucocorticoid (t(t152152 = 3; h)= 3; h)

    7eamethasone7eamethasone 22 00 04 m% tab404 m% tab4 !m%5ml in (i4m4, i44)!m%5ml in (i4m4, i44)

    #etamethasone#etamethasone 22 00 04, 1 m% tab404, 1 m% tab4

    !m%5ml in (i4m4, i44)!m%5ml in (i4m4, i44)

    aramethasonearamethasone 1010 00 2- 20 m%5day (oral)2- 20 m%5day (oral)

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    'ineralocorticoids -'ineralocorticoids - reparationsreparations

    7ru%7ru% nti-nti- inflammatoryinflammatory

    $alt retainin%$alt retainin% reapartions +reapartions + dosedose

    /ludrocortisone/ludrocortisone 1010 1010 100 mc% tab4100 mc% tab4

    7>C7>C 00 100100 24 m%24 m% sublin%ualsublin%ual

    ldosteroneldosterone 043043 30003000 ?ot used?ot used clinicallyclinically

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    I#hala#" S"$roids2 Bro#!hial As"h%aI#hala#" S"$roids2 Bro#!hial As"h%a

    #eclomethasone#eclomethasone dipropionatedipropionate

    0,100,200 mc%5md inhaler 0,100,200 mc%5md inhaler 

    100, 200, !00 mc% @otacaps100, 200, !00 mc% @otacaps

    /luticasone/luticasone propionatepropionate

    2, 0 mc%5md inhaler 2, 0 mc%5md inhaler 

    2,0,125md '7I2,0,125md '7I

    0, 100, 20 mc% @otacaps0, 100, 20 mc% @otacaps

    #udesonide#udesonide 100,200 mc%5md inhaler 100,200 mc%5md inhaler  042, 04 m%5ml respules042, 04 m%5ml respules

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    7ru%7ru% Topical preparationTopical preparation otencyotency

    #eclomethasone#eclomethasone

    dipropionatedipropionate

    0402 . cream0402 . cream otentotent

    #etamethasone benoate#etamethasone benoate + #4 alerate+ #4 alerate

    0402 . cream, ointment0402 . cream, ointment

    0412 . cream, ointment0412 . cream, ointment

    otentotent

    Clobetasol propionateClobetasol propionate 040 . cream040 . cream otentotent

    AalcinonideAalcinonide 041 cream041 cream otentotent

    Triamcinolone actonideTriamcinolone actonide 041 . ointment041 . ointment otentotent

    /luocinolone actonide/luocinolone actonide 0402. ointment0402. ointment 'oderate'oderate

    'ometasone'ometasone 041 . cream, ointment041 . cream, ointment 'oderate'oderate

    /luticasone/luticasone 040 . cream040 . cream 'oderate'oderate

    Aydrocortisone acetateAydrocortisone acetate 24 . ointment24 . ointment 'oderate'oderate

    Aydrocortisone acetateAydrocortisone acetate 041 B 140. ointment041 B 140. ointment 'ild'ild

    Topical steroids

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    Topical $teroidsTopical $teroids

    #enefits due to anti-inflammatory, immunosuppressie,

    asoconstrictor and anti-proliferatie actions

    Good r$s&o#s$Good r$s&o#s$ Slo. r$s&o#s$Slo. r$s&o#s$

    topic ecema,topic ecema,

    ller%ic contact dermatitis,ller%ic contact dermatitis,

    &ichen simple,&ichen simple,

    rimary irritant dermatitis,rimary irritant dermatitis,

    $eborrheic dermatitis,$eborrheic dermatitis,

    soriasis of face,soriasis of face,

    "aricose"aricose ecemaecema

    Cystic acneCystic acne

    lopecia areatalopecia areata

    7iscoid &7iscoid &

    Aypertrophied scarsAypertrophied scars

    DeloidsDeloids &ichen planus&ichen planus

    soriasis of palm, sole,soriasis of palm, sole,

      elbo< + kneeelbo< + knee

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    Topical $teroidsTopical $teroids

     enetration differs at different sites*enetration differs at different sites* 

    Ai%h*Ai%h* ailla, %roin, face, scalp, scrotumailla, %roin, face, scalp, scrotum 'edium*'edium* limbs, trunklimbs, trunk

    &o

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    Therapeutic principlesTherapeutic principles