KONSELING PEDIATRIKONSELING PEDIATRI

RESEP1RESEP1R/ R/ IsoniazideIsoniazide 300 tab 7tab300 tab 7tabmf mf pulfpulf 15 15 S. S. SehariSehari 1x11x1

nn R/ R/ RifampicinRifampicin 300 cap 13 tab300 cap 13 tabmf 1pulf 15 mf 1pulf 15 S.SehariS.Sehari 1 x11 x1

nn R/ R/ PyrazinamidPyrazinamid 500 tab 15 tab500 tab 15 tabS.SehariS.Sehari 1x11x1

Pro: Pro: LitaLita

KONSELING 1KONSELING 1Problem/AssessmentProblem/Assessmentnn PemakaianPemakaian pyrazinamidpyrazinamid : : hanyahanya 2 2 bulanbulan

dandan selamaselama iniini harusharus kontrolkontrol tiaptiap 15 15 hariharinn SetelahSetelah 2 2 bulanbulan , , kontrolkontrol sebulansebulan sekalisekali

((tanpatanpa PZA)PZA)nn VitVit B6 B6 utkutk peripheral neuropathyperipheral neuropathy

KONSELINGKONSELINGActionActionnn 3 Prime Questions3 Prime Questionsnn SudahSudah berapaberapa lama lama minumminum obatobat? ? MinumMinum obatobat lain?lain?nn Adherence, Adherence, bilabila tidaktidak àà resistensiresistensinn BilaBila lupalupa minumminum obatobatnn EfekEfek sampingsamping RifampisinRifampisinnn JagaJaga gizigiziMonitoringMonitoringnn CekCek fungsifungsi hatihati sebelumsebelum dandan selamaselama minumminum obatobat??nn TB TB --

RESEP 2RESEP 2nn R/ R/ IsoniazideIsoniazide 300 tab 5 tab300 tab 5 tabnn R/ R/ VitVit B6 10 tab 15tabB6 10 tab 15tabnn R/R/RifampicinRifampicin 300 cap 10 tab300 cap 10 tab

mf 30 mf 30 bungkusbungkusS: S: seharisehari 1x1 1x1 bungkusbungkus

nn CurbexonCurbexon syrsyr 100ml100mlS: S: SehariSehari 1 x 1 1 x 1 sendoksendok obatobat

Pro: Pro: DilaDila

KONSELING 2KONSELING 2

nn PyrazinamidePyrazinamide sudahsudah tidaktidak dipakaidipakai lagilaginn KontrolKontrol 30 30 harihari

RESEP 3RESEP 3

nn R/R/SalbutamolSalbutamol 2 mg tab 5 tab2 mg tab 5 tabmf 10 mf 10 bksbksS. S. SehariSehari 2 x 1 2 x 1 bungkusbungkus

nn HistrineHistrine 5 5 syrsyr 1 fl1 flS. S. SehariSehari 1 x 1//2 1 x 1//2 sendoksendok obatobat

nn VentolinVentolin NebulNebul 1 amp 21 amp 2S. S. SerahKanSerahKan keke dokterdokter

Pro: Pro: SitiSiti anakanak

KONSELING 3KONSELING 3Problem Problem AssesmentAssesment

nn 3 PQ 3 PQ nn Mild persistent, moderate Mild persistent, moderate persitentpersitent, severe , severe

persistent?persistent?nn RiwayatRiwayat keluargakeluarga? ? RiwayatRiwayat pengobatanpengobatan asmaasma

atauatau yang lain.yang lain.nn PernahPernah dirawatdirawat didi RS? RS? nn PencetusPencetus asmaasma ? ? UpayaUpaya ? ? HindariHindarinn SimtomSimtom dandan durasidurasi??nn KesulitanKesulitan minumminum obatobat??

ActionActionnn SalbutamolSalbutamol janganjangan sampaisampai lupalupa diminumdiminum, ,

caranyacaranya……nn TandaTanda--tandatanda awalawal, , disekolahdisekolah atauatau pergipergi jauhjauh

tanpatanpa ortuortu....nn JadwalJadwalnn UntukUntuk moderate moderate dandan severe exacerbations severe exacerbations àà

cairancairan penggantipengganti dandan mimasimimasi sekresisekresi yang yang kentalkental

nn Cara Cara pakaipakai inhaler: corticosteroid inhaler: corticosteroid harusharus kumurkumursetelahsetelah selesaiselesai

nn FarmasisFarmasis harusharus yakinyakin bahwabahwa pasienpasien fahamfahamperbedaanperbedaan obatobat untukuntuk pemeliharaanpemeliharaan((kortikosteroidkortikosteroid) ) dandan pelegapelega nafasnafas((BronkhodilatorBronkhodilator))

M. MonitoringM. Monitoring

RESEP 4RESEP 4R/ R/ CohistanCohistan exp 60 ml 1exp 60 ml 1

S. S. seharisehari 3 x 1 3 x 1 ½½ sendoksendok obatobat

R/ R/ LamesonLameson 8 tab 35 8 tab 35 S. S. SehariSehari 1 x 11 x 1

R/R/AskamexAskamex 25 tab 3025 tab 30S. S. SehariSehari 1 x 2 tab1 x 2 tab

Pro: Pro: AlamAlam

KONSELING 4KONSELING 4P. P. nn 3 PQ3 PQnn RiwayatRiwayat penyakitpenyakit dandan obatobat??nn Batuk,pilekBatuk,pilek? ? GinjalGinjal? Abstract? Abstract Acute Acute

interstitial nephritis (AIN) is a known cause of interstitial nephritis (AIN) is a known cause of acute renal failure in children ?acute renal failure in children ?

nn KortikosteroidKortikosteroid untukuntuk (AIN) (AIN) dandan lamesonelamesone((meningkatkanmeningkatkan imuneimune system)system)

Diagnosis and management of acute Diagnosis and management of acute interstitial nephritisinterstitial nephritis..

nn KodnerKodner CMCM, , KudrimotiKudrimoti AA..nn Department of Family and Community Medicine, University of LouisDepartment of Family and Community Medicine, University of Louisville ville

School of Medicine, Louisville, Kentucky 40202, USA.School of Medicine, Louisville, Kentucky 40202, USA.nn Acute interstitial nephritis is an important cause of acute renaAcute interstitial nephritis is an important cause of acute renal failure l failure

resulting from immuneresulting from immune--mediated mediated tubulointerstitialtubulointerstitial injury, initiated by injury, initiated by medications, infection, and other causes. Acute interstitial nepmedications, infection, and other causes. Acute interstitial nephritis may be hritis may be implicated in up to 15 percent of patients hospitalized for acutimplicated in up to 15 percent of patients hospitalized for acute renal e renal failure. Clinical features are essentially those of acute renal failure. Clinical features are essentially those of acute renal failure from any failure from any cause, and apart from a history of new illness or medication expcause, and apart from a history of new illness or medication exposure, osure, there are no specific history, physical examination, or laboratothere are no specific history, physical examination, or laboratory findings ry findings that distinguish acute interstitial nephritis from other causes that distinguish acute interstitial nephritis from other causes of acute renal of acute renal failure. Classic findings of fever, rash, and failure. Classic findings of fever, rash, and arthralgiasarthralgias may be absent in up may be absent in up to two thirds of patients. Diagnostic studies such as urine to two thirds of patients. Diagnostic studies such as urine eosinophilseosinophils and and renal gallium 67 scanning provide suggestive evidence, but they renal gallium 67 scanning provide suggestive evidence, but they are unable are unable to reliably confirm or exclude the diagnosis of acute interstitito reliably confirm or exclude the diagnosis of acute interstitial nephritis. al nephritis. Renal biopsy remains the gold standard for diagnosis, but it mayRenal biopsy remains the gold standard for diagnosis, but it may not be not be required in mild cases or when clinical improvement is rapid aftrequired in mild cases or when clinical improvement is rapid after removal er removal of an offending agent or medication. The time until removal of sof an offending agent or medication. The time until removal of such agents, uch agents, and renal biopsy findings, provide the best prognostic informatiand renal biopsy findings, provide the best prognostic information for return on for return to baseline renal function. to baseline renal function. Corticosteroids appear to provide some benefit in Corticosteroids appear to provide some benefit in terms of clinical improvement and return of renal function, but terms of clinical improvement and return of renal function, but no controlled no controlled clinical trials have been conducted to confirm thisclinical trials have been conducted to confirm this..

DrugDrug--induced induced granulomatousgranulomatous interstitial nephritis interstitial nephritis

in a pediatric patientin a pediatric patientJournalJournalPediatricPediatric NephrologyNephrology

IssueIssueVolumeVolume 22, Number 2 / February, 200722, Number 2 / February, 2007nn AbstractAbstract Acute interstitial nephritis (AIN) is a known cause of acute Acute interstitial nephritis (AIN) is a known cause of acute

renal failure in children. In most instances, drug therapy is threnal failure in children. In most instances, drug therapy is the e offending agent. Although offending agent. Although granulomagranuloma formation has been observed formation has been observed in drugin drug--induced interstitial nephritis, it is not a commonly associated induced interstitial nephritis, it is not a commonly associated manifestation. This is a case of a 15manifestation. This is a case of a 15--yearyear--old white female with old white female with TetralogyTetralogy of of FallotFallot and pulmonary and pulmonary atresiaatresia who developed acute who developed acute renal failure secondary to drugrenal failure secondary to drug--induced interstitial nephritis and induced interstitial nephritis and renal renal granulomasgranulomas. In addition to interstitial edema with . In addition to interstitial edema with eosinophilseosinophilsand lymphocytes, her renal biopsy showed interstitial and lymphocytes, her renal biopsy showed interstitial granulomasgranulomas, , immune complexes within tubular basement membranes, and the immune complexes within tubular basement membranes, and the unusual feature of multinucleated giant cells engulfing tubules.unusual feature of multinucleated giant cells engulfing tubules. Her Her acute renal failure resolved after the withdrawal of antibioticsacute renal failure resolved after the withdrawal of antibiotics and and the initiation of intravenous steroid therapy. the initiation of intravenous steroid therapy.

nn KeywordsKeywords GranulomasGranulomas -- Interstitial nephritisInterstitial nephritis -- Acute renal failureAcute renal failure --Drug reaction Drug reaction

ActionActionnn LamesoneLamesone: : seharisehari 1 x 1 1 x 1 setelahsetelah makanmakan, ,

pagipagi hariharinn AskamexAskamex: : meningkatkanmeningkatkan immune systemimmune system

MonitoringMonitoringnn FungsiFungsi ginjalginjalnn EfekEfek sampingsamping lamesonelamesone??

RESEP 5RESEP 5nn CefiximeCefixime 100 100 syrsyr 30ml 130ml 1

S. S. SehariSehari 2 x 2 x ½½ sendoksendok obatobatHabiskanHabiskan sesuaisesuai aturanaturan

nn Lacto B Powder 1 G 10Lacto B Powder 1 G 10S. S. SehariSehari 2 x 1 2 x 1 bungkusbungkus

nn RenalyteRenalyte 200ml 2200ml 2S. S. minumminum selamaselama diare/muntahdiare/muntah

Pro: Pro: DedenDeden

KONSELING 5KONSELING 5nn P. P.

nn 3PQ3PQnn DiareDiare ??nn Lacto B. : Lacto B. : menyeimbangkanmenyeimbangkan populasipopulasi floraflora

Action:Action:nn CairanCairan cukupcukupnn GejalaGejala dehidrasidehidrasi, , kapankapan harusharus keke dokterdokter lagilagi/ RS/ RSMonitoring:Monitoring:nn FrekuensiFrekuensi diare/muntahdiare/muntahnn SuhuSuhu badanbadannn DehidrasiDehidrasi

RESEP6RESEP6R/ R/ LactulaxLactulax syrsyr 60ml60ml

S. S. SehariSehari 3 x2 3 x2 sendoksendok obatobatR/ R/ MicrolaxMicrolax 5ml5ml

S. S. DimasukkanDimasukkan keke dalamdalam anusanus

Pro : Pro : DanuDanu

KONSELING 6KONSELING 6ProblemProblemnn KonstipasiKonstipasi, , LactulaxLactulax: : lactuloselactulose, , pelunakpelunak, simple , simple

sugar, sugar, hatihati--hatihati DM (DM (efekefek BAB normalBAB normalàà 2424--48 48 jam), jam), MicrolaxMicrolax: sodium : sodium laurilsulfoacetatelaurilsulfoacetate, , efekefek30 30 menitmenit

ActionActionnn Cara Cara memakaimemakai microlaxmicrolax: : puntirpuntir, , bukabuka tutupnyatutupnya, ,

pencetpencet tubetubeàà keluarkeluar sedikitsedikit utkutk melumasmelumas ujungujungtube, tube, masukkanmasukkan keke rectum rectum penuhpenuh ((dewasadewasa), ), setengahsetengah ((anakanak <3 <3 thnthn))

nn PencetPencet tube, tube, keluarkankeluarkan nozzlenozzle

ActionActionnn MinumMinum banyakbanyak airairnn TingkatkanTingkatkan asupanasupan seratseratnn JanganJangan memakaimemakai laxative laxative berlamaberlama--lamalamaàà

ketergantunganketergantungannn BilaBila simtomsimtom tidaktidak hilanghilangàà keke dokterdokterMonitorMonitornn KualitasKualitas dandan frekuensifrekuensi BABBAB

KASUS 7

nn AntoAnto anakanak 2 2 tahuntahun, , sakitsakit perutperut beberapabeberapamingguminggu. Rata. Rata--rata BAB 1 x rata BAB 1 x semingguseminggu. . SetiapSetiap kali BAB kali BAB menangismenangis. . SetelahSetelahdiperiksadiperiksa dokterdokter, , dokterdokter menentukanmenentukanbahwabahwa AntoAnto mengalamimengalami functional constipation

KONSELING 7KONSELING 7

n Sebelum mulai terapi, harus dilakukandisimpaction

n Sebaiknya secara oral: mineral oil, PEG, Bisacodyl, oral lebih baik dibanding supositoria

n Maintenance therapy:n Perilakun Diet: cukup cairan & seratn Medication therapy: mineral oil, lactulose, sorbitol, à

sampai 1-2 soft stools sehari.

KASUS 8KASUS 8

nn BagusBagus, , bayibayi 12 12 bulanbulan, 10kg. , 10kg. AnakAnak iniini baikbaik--baikbaik kemarinkemarin. . SekarangSekarang sudahsudah 24 jam 24 jam demamdemam dandan rewelrewel. 15 . 15 menitmenit yllyll 39C. 39C. DokterDokter mengatakanmengatakan kemungkinankemungkinan infeksiinfeksivirus. virus. IbunyaIbunya khawatirkhawatir, , kalaukalau makinmakin panaspanasdandan kejangkejang..

nn BayiBayi <2 <2 bulanbulan dengandengan suhusuhu >37.7 C >37.7 C ààevaluasievaluasi keke dokterdokter: : kulturkultur darahdarah, , analisaanalisaurinurin, lumbar puncture. , lumbar puncture. BiasanyaBiasanya diberidiberiantibiotikaantibiotika sambilsambil menunggumenunggu hasilhasil

nn BayiBayi 66--24 24 bulanbulan dengandengan suhusuhu >38.9 C, >38.9 C, WBC <5.000 WBC <5.000 atauatau >15.000/mm3 >15.000/mm3 àà resikoresikobakterimiabakterimia

nn AnakAnak semuasemua umurumur >41 C >41 C àà bakterimiabakterimiaatauatau meningitismeningitis

n Kejang karena panas terjadi pada 2-4% anak antara 6 bulan-5 tahun, Penyebabtidak diketahui, diduga ada faktor genetik. Ada 2 macam febrile seizures : <15 menitdan yang terjadi secara seri dalam waktu24 jam episoda demam.

PENGOBATAN KASUS 8

nn AsetaminofenAsetaminofen oral/oral/rektalrektal: 10: 10--15mg/kg 15mg/kg perdosisperdosis setiapsetiap 44--6jam 6jam bilabila perluperlu, , maksimalmaksimal 65mg/kg/hari65mg/kg/hari

nn (first line drug in children)(first line drug in children)nn Ibuprofen 5Ibuprofen 5--10mg/kg 10mg/kg setiapsetiap 66--8 jam 8 jam

maksimummaksimum 40mg/kg 40mg/kg perhariperhari..nn Aspirin: Aspirin: hatihati--hatihati Reye Reye syndromsyndrom untukuntuk

demamdemam karenakarena virusvirus

KEANEKARAGAMAN DOSIS

60mg/0.6ml60mg/0.6ml250mg/5ml250mg/5mlNaprexNaprex

150mg/5ml150mg/5mlBiogesicBiogesic

XXXXXXXXXXXXXXXX60mg/0.6ml60mg/0.6ml

120mg/5ml120mg/5ml120mg/5ml120mg/5ml

ParacetolParacetolSanmolSanmol

60mg/0.6ml60mg/0.6ml160mg/5ml160mg/5mlPanadolPanadol

asetaminofenasetaminofen80mg/0.8ml80mg/0.8ml160mg/5ml160mg/5mlTempraTempra

DropsDropssirupsirup

KASUS 9KASUS 9

n R/Aspilet 10 tabS. 2x ½ tabPro: Nina

n Anak dengan penyakit jantungn Crushed + sedikit airn Bila sudah bau salisilatà Jangan dipakain Dosis : n High dose aspirin during acute phase for its

antiinflamatory effect: 80-100mg/kg/hari diikuti

n Low dose aspirin for its antiplatelet effect 3-5mg/kg/hari selama 7 minggu atau lebih.

KASUS 10

n Ita 3 bulan, nasal congestion, pilek, batukkemarin. Tidak demam, tetapi kurangnyenyak tidurnya. Ibu Ita menilpondokter, kemungkinan flu karena virus.

n Ruangan diberi humidifiern Saline drops (sebelum menyusui)n Kalau diperlukan topical decongestan:

phenylephrin (jangan oxymetazolin atauxylometazolin), dibatasi 3-5 hari maksimum.

n Antitusif jangan dipakai kalau batuk produktif, bermanfaat untuk batuk yang kering danmengganggu tidur.

n Expektoran (ct:guaifenesin) à tdk efektifn Vit C, echinacea mencegah common cold, belum

cukup bukti.

DIAPER RASHRUAM POPOK

nn BayiBayi AniAni 3 3 bulanbulan, , ““severe diaper severe diaper rashrash””(ruam(ruam popokpopok) ) selamaselama 4 4 harihari. . DaerahDaerahpantatpantat merahmerah, , bengkakbengkak..

nn R/R/clotrimazolclotrimazol 1% cream1% cream

KONSELING 1KONSELING 1nn KemungkinanKemungkinan infeksiinfeksi candidacandida: : merahmerah, >3 , >3 harihari, , nn DiobatiDiobati dengandengan clotrimazolclotrimazol atauatau miconazolmiconazol

cream, 4 X cream, 4 X seharisehari. . PadaPada kulitkulit yang yang telahtelahdibersihkandibersihkan. .

nn GantiGanti popokpopok setiapsetiap 22--4 jam (4 jam (kalaukalau pakaipakaipampers)pampers)

nn DaerahDaerah popokpopok harusharus selaluselalu bersihbersih, , dandan keringkering..nn BilaBila parahparah: 0.5%: 0.5%--1% 1% hidrokortisonhidrokortison : 2 x : 2 x sehariseharinn SelanjutnyaSelanjutnya dicegahdicegah dengandengan menggantimengganti popokpopok

lebihlebih seringsering, , kebersihankebersihan dijagadijaga..