k9_farmakologi.pptx
TRANSCRIPT
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 1/35
Dr. IIT FITRIANINGRUM
DEPARTEMEN FARMAKOLOGI
OBAT ANTIMIKOBAKTERI
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 2/35
Infeksi mikobakteri suit !isembu"kan !ari semua #enis bakteri
Mikobakteri ambat berkemban$%reatif resisten t"!
antibiotik%akti&itas ter$antun$ 'e(atn)a se
membea"Da(at men#a!i !ormant *ti!ak aktif+ s"$ m#! san$at
resisten t"! berba$ai #enis obat
Dibunu" san$at ambat oe" bbr( obat )an$ aktif
Din!in$ se mikobakteri ka)a akan i(i! )an$ suit!itembus% (ro(orsi )an$ bermakna !i intrase%t!(t!m makrofa$susa" !itembus oe" obat !$n(enetrasi ema"
O&er&ie,
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 3/35
Men)embu"kan
Men'e$a" kematian
Men'e$a" kekambu"an
Memutuskan rantai (enuaranMen'e$a" ter#a!in)a resistensi kuman t"!
OAT
TU-UAN PENGOBATAN TB
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 4/35
obat ini (ertama
/. Isonia0i!
1. Rifam(in
2. P)ra0inami!
3. et"ambuto
4. stre(tom)'in
Antimikroba !aam (en$obatan Tuber'uosis
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 5/35
Obat ini ke!ua
/. Amika'in
1. Aminosai')i' a'i!
2. 5a(reom)'in
3. 5i(ro6o7a'in
4. 5ofa0imine
8. 5)'oserine
9. Et"ionami!e
:. Le&o6o7a'in
;. Rifabutin
/<. Rifa(entin
Obat antimikroba !aam(en$obatab Tuber'uosis
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 6/35
Rejimen Lama pengobatan(dalam bulan)
Isonia0i!%rifam(in%()ra0inami!e
8
Isonia0i!% rifam(in ;
Rifam(in% et"ambuto%()ra0inami!e
8
Rifam(in% et"ambuto /1
Isonia0i!% et"ambuto /:
Lama (en$obatan TB )an$!irekomen!asikan
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 7/35
Mu!a" arut !aam air
=truktur miri( ()ri!o7ine
=e'ara in &itro% men$"ambat besar basi
tuberke (a!a konsentrasi <%1 m(>mLBakterisi! basi tuberke )an$ se!an$ aktif
berkemban$
Kuran$ efektif utk mea,an #enis mikobakteri
ati(ikaAktif mea,an or$anisme ekstrase !an
intrase
I=ONIA?ID
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 8/35
Men$"ambat sintesis !ari mycolic acid yangada pada dinding sel mikobakteri
Mutan resisten se$era terseeksi #ika isonia0i!
!iberikan seba$ai obat tun$$a
MEKANI=ME KER-A
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 9/35
Isoniazid an$sun$ !isera( !ari sa 'erna
Dosis (er ora 2<< m$*4 m$>k$BB utk anak@anak+
Ber!ifusi 'e(at !aam !ara" ke seuru" 'airantubu" !an #arin$an
Metaboit isonia0i! !an seba$ian ke'i obat!aam bentuk teta( !ikeuarkan meaui urin
Pa!a (asien $a$a $in#a !osisn)a />2@/>1 !ari!osis norma
FARMAKOKINETIK
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 10/35
Isonia0i! !iin!ikasikan utk (en'e$a"antuberkuosis (a!a in!i&i!u )an$ kontak erat!en$an kasus tuberkuosis (umoner aktif
In!i&i!u imunokom(ris *(asien I !an AID==eba$ai (en'e$a"an !ari tuber'uosis aktif
(a!a in!i&i!u )an$ terinfeksi M.tuber'uosis!en$an tes tuberkuin (ositif
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 11/35
Reaksi aer$i ruam kuit% !emam #aran$ ter#a!i
Toksisitas "e(atitis *ke"ian$an nafsu
makan%mua%munta"%ikterus%n)eri kua!ran kananatas+sto( obat
Penin$katan aminotransferase *"in$$a 2@37+ tan(a$e#aa ti!ak (eru (en$"entian obat
Neuro(ati (erifer (a!a (asien !$n !osis ebi" !ari
4m$>k$bb>"ari%(a!a (asien !$n
manutrisi%ako"oisme%DM%AID= !an uremia.Anemia akibat !eCsiensi ()ri!o7ine
Menurunkan metaboisme ("en)toin%s"$ ka!arn)amenin$katefek toksik
Efek =am(in$
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 12/35
Aktif se'ara in &itro mea,an kokkus $ram !an $ram@% bakteri enterik% mikobakteri !anchlamydia
Pemberian Rifam(in seb$ai obat tun$$amen)eeksi or$anisme@or$anisme resistensitin$$i
Ti!ak ter!a(at resistensi sian$ !$n
antimikroba ain%ke'uai !$n turunann)a%se(erti rifabutin
Bersifat bakterisi! t"! mikobakteri
Rifam(in !a(at membunu" or$anisme )an$
ta"an t"! b)k #enis obat
RIFAMPIN
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 13/35
Disera( !en$an baik se'ara (er ora%!iekskresikan meaui "ati menu#u em(e!u
Resirkuasi t#! !i entero"e(atis km!!iekskresikan !aam #uma" besar sb$metaboit (! feses !an se#uma" ke'i (! urin
Di!istribusikan se'ara uas !aam 'airantubu" !an #arin$an
Pen$ikat (rotein )an$ reatiftin$$i%konsentrasin)a (a!a L5= "an)a bia t#!(era!an$an (! sea(ut otak atau ==.tuan$beakan$
FARMAKOKINETIK
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 14/35
Dosis Rifam(in 8<<m$>"ari */< m$>k$bb>"ari+ (erora !iberikan bersama isonia0i!%et"ambuto !an OAT)$ ain utk men$"in!ari resistensi obat
=eba$ai (roCaksis isonia0i!%(a!a (asien1 )an$
ti!ak !(t men$konsumsi isonia0i! seba$ai (roCaksis kontak (a!a anak !en$an
.in6uen0a ti(e B
Kombinasi Rifam(in utk (en$obatan infeksi
=taCo'o''us serius *osteomieitis% en!okar!itis+Kombinasi !en$an 5eftria7one atau &an'om)'in utk
menin$itis o.k (neumo'o''us )$ resisten t"!(enisiin
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 15/35
arna oran)e )$ ti!ak berba"a)a (a!a
urin%kerin$at%air mata !an ensa kontak
Ruam kuit%trombosito(enia%nefritis
Ikterus"e(atitis
Proteinuria rin$an=in!r.miri( 6u bia (emberian kuran$ !ari 17semin$$u
Men$eiminasi obat ain *men$in!uksi en0immikrosom+ met"a!one%antikoa$uasi%bbr(
antikon&usan%(en$"ambat (rotease%kontrase(siMenurunkan ka!ar serum !ari
ketokona0o%')'os(orine%'"oram("eni'o
EFEK =AMPING
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 16/35
sen)a,a sintetis )an$ arut !m air !an ta"an(anas
Pen$"ambat !ari arabinosyl transferasemikobakteri
Arabynosyl transferase teribat !aam(oimerasi arabino$)'an *kom(onenessensia (! !in!in$ se+
Gan$$uan sintesis arabino$)'anmen$$an$$u (erta"anan se% menin$katkanakti&itas obat1 i(oCik *rifam(in !ano6oksasin+
Disera( !en$an baik meaui usus
ETAMBUTOL
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 17/35
Akumuasi et"ambuto t#! (! $an$.$in#a%!osis!ikuran$i "in$$a se(aru"n)a *#ika kirenskreatinin /< mL>menit+
Menembus sa,ar otak "an)a #ika sea(ut otakterinfeksi
Resistensi et"ambuto t#! 'e(at #ika !iberikansb$ obat tun$$a
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 18/35
Dosis (er ora /4@14 m$>k$ !iberikan se'aratun$$a !$n !osis "arian kombinasi isonia0i!atau rifam(in
Dosis )an$ tin$$i untuk (en$obatanmenin$itis tuber'uosa
Dosis et"ambuto 4<m$>k$ utk #a!,a(emberian !osis !ua kai !m semin$$u
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 19/35
Neuritis retrobuber"ian$n)a ta#am(en$i"atan !an buta ,arna mera"@"i#au
Pemberian !osis "in$$a 14m$>k$ terusmenerus seama berbuan1 berefek (a!ata#am (en$i"atan
Kontrain!ikasi (a!a anak1
EFEK =AMPING
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 20/35
=e#enis ni'otinami!e%stabi%se!ikit arut !aamair% 'uku( mura"
( netra%ti!ak aktif in &itro% (a!a ( 4%4 !(tmen$"ambat basi tuberke !an bbr( #enismikobakteri
Obat !isera( oe" makrofa$ !an akti&itasn)amea,an or$anisme intraseuer )an$ t!(t
(a!a in$k.asam
PHRA?INAMIDE
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 21/35
Dosis 14 m$>k$>"ari (er ora
Disera( !ari sauran 'erna !an !i!istribusikanse'ara uas ke #arin$an tubu" termasuksea(ut otak )$ terinfeksi
aktu (aru" :@// #am
Re#imen (en$obatan !osis 4<@9<m$>k$ !uakai semin$$u atau ti$a kai semin$$u
Diberikan bersama1 rifam(in !an isonia0i!sb$ a$en sterii0atorJ aktif utk mea,an sisa@sisa or$anisme intraseuer
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 22/35
Resistensi t#! san$at 'e(at%t( t!k t#! resistensisian$ !$n antimikobakteri )$ ain
Kombinasi ()ra0inami!e !$n 'i(ro6o7a'inatau o6oksasin utk (en'e$a"an aktif (!kontak erat (en!erita Tb%!an (! kasus Tb)an$ resisten t"! berba$ai ma'am obat
Efek sam(in$ "e(atotoksik %mua%munta"
!emam% "i(erurisemia
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 23/35
=eba$ian basi@basi tuberke !i"ambat oe"stre(tom)'in
=(esies mikobakteri non tuber'uosissemuan)a resisten ke'uai M.a&ium 'om(e7*MA5+ !an M)'oba'terium kansasii
=uit menembus ke !aam se%s"$ "n)a aktifutk mea,an basi tuberke ekstraseuer
Menembus sa,ar otak !an men'a(ai !osistera(eutik (!a ra!an$ sea(ut otak
=TREPTOMH5IN
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 24/35
Dosis /4m$>k$>"ari s'r i.m atau i.& setia("ari utk !e,asa% anak1 1<@3< m$>k$>"ariti!ak ebi" !ari /@/%4 $ utk bbr( min$$u
Obat@obat ain !iberikan s'r simutan utkmen'e$a" resistensi
Efek sam(in$ ototoksik !annefrotoksik%&erti$o.
Dosis !isesuaikan !$n fun$si $in#aEfek toksik !(t !ikuran$i #ika (en$$unaan
ti!ak ebi" !ari 8 bn
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 25/35
Ber"ubun$an !en$an isonoa0i! men$"ambat mycolicacid
=uit arut !aam air % !imetaboisme !i "ati
=eba$ian besar basi tuberke !i"ambat se'ara in &itro
Dosis a,a 14< m$ sekai se"ari !$n tia( kenaikan14< m$ !osis )an$ !irekomen!asikan /$>"ari*/4m$>k$>"ari+ #aran$ !(t !itoeransi
Men)ebabkan iritasi )an$ serius (a!a ambun$ !an
$e#aa neuroo$ise(atotoksik
T#! resistensi sian$ antara isonia0i! !an et"ionami!e
ETIONAMIDE
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 26/35
Antibiotik (e(ti!a (en$"ambat sintesis(rotein !i"asikan !ari Streptomycescapreolus
=e'ara in &itro men$"ambat ban)akmikobakteri tmasuk M.tuber'uosis
=train M.tuber'uosis )an$ resisten t"!=tre(tom)'in atau amika'in%rentan t"!
5a(reom)'inBersifat nefretoksik !an ototoksik
*tinitus%tui%$an$.&estibuer+
Dosis sama !$n stre(tom)'in
5a(reom)'in
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 27/35
Pen$"ambat sintesis !in!in$ se
Men$"ambat berba$ai strain M.tuber'uosis
Dosis utk Tb <%4@/ $>"ari !iba$i !m 1 !osis
Diekskresikan !i $in#a% !osis !ikuran$i #ikakirens kreatinin 4< mL>menit
Neuro(ati (erifer !an !isfun$si sistem (usat*!e(resi%$e#aa (sikosis+
Diberikan bersama !$n ()ri!o7ine /4<m$>"ari
5)'oserin
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 28/35
='r in &itro men$"ambat basi tuberke
Mu!a" !isera( sauran 'erna
Dosis :@/1 $>"ari (.o *!e,asa+% 2<<
m$>k$>"ari *anak1+Di!istribusikan ke #arin$an !an 'airan
tubu"%ke'uai L5=
Diekskresikan !i urin%konsentrasi tin$$i
menimbukam kristauriaEfek sam(in$ (a!a GI
e(atotoksik #ika !iberikan 2@: min$$u
AMINO=ALI5HLI5 A5ID *PA=+
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 29/35
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 30/35
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 31/35
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 32/35
WHO 1R99?9=9 > 3R99*=9 ATAU E9+ 3R22
9 9E9
99T9DEPKES 1R99E9?9> 3R22
PULMONOLOG 1R99E9?9 > 3R99
3R22
99E9
/=T 5ATEGORH
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 33/35
WHO 1R99E9?9=9 > /R99?9E9
4R99E9 ATAU
4R22F2 *FULLH =UPERI=ED+
DEPKES 1R99E9?9=9 > /R99E9?9
> 4R22E2
PULMONOLOG 1R99E9?9=9>/R99E9?9>
8R99E9 ATAU
8R22E2
1ND 5ATEGORH
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 34/35
WHO @ 1R99?9>1R99@ 1R22?2>1R22
8929
DEPKES @ 1R99?9>3R22
PULMONOLOG @ 1R99?9>3R99
@ 1R22?2>3R22
!HRON"! #$ IN FOR LIFE
2RD 5ATEGORH
7/17/2019 K9_Farmakologi.pptx
http://slidepdf.com/reader/full/k9farmakologipptx 35/35
#%an& 'ou