konsep interaksi obat

8/18/2019 KONSEP INTERAKSI OBAT

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KONSEP

INTERAKSIOBAT

Nurul Maziyyah, M.Sc., Apt.

Prodi Farmasi FKIK UMY

201


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Outline...

Pendahuluan

Macam – Macam Interaksi Obat

Faktor Obat

Faktor Pasien

Faktor ainn!a Si"ni#kansi Interaksi


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P!"dahulua"

Drug-Related Problem

Pro#l!ma t!r$ait

o#at %$!#utuha"da"&atau harapa"

atas t!rapi'

Farmasis

id!"ti(i$asi )p!"*atasa" +P


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-utcom! t!rapi i"t!ra$si pasi!", li"*$u"*a",

o#at, da" p!"ya$it


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P!"dahulua"...cont’d

Drug Interaction

I"t!ra$si ya"* t!radi a"tara o#at d!"*a"

s!"ya/a lai" %(armas!tis&(arma$o$i"!ti$&

(arma$odi"ami$' ya"* dapat #!rp!"*aruh

t!rhadap !(!$ o#at

+ampa$ "!*ati( i"t!ra$si o#at

Kadar o#at #!rl!#ih

Kadar o#at $ura"*

-#at rusa$

P!ra" Farmasis

!(!$ to$si$

!(!$ tida$t!rcapai

tida$ #!r!(!$ s!suai

i"di$asi atau !(!$ "!*ati(


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S!ma$i" #a"ya$ o#at ya"* di$o"sumsi, s!ma$i" #!sar

r!si$o t!radi"ya r!a$si ya"* tida$ dii"*i"$a"

$!adia" r!a$si ya"* tida$ dii"*i"$a" s!#!sar 3 pada

pasi!" ya"* m!"!rima 4 10 o#at tapi 503 pada pasi!"

ya"* m!"!rima 1 4 20 macam o#at disproportionate

increase %Smith d$$, 166' 7asil p!"!litia" di s!#uah SUP m!"u"u$$a" $!adia"

i"t!ra$si o#at s!#!sar 863 pada pasi!" ra/at i"ap da"

63 pada pasi!" ra/at ala" %ahma/ati et al, 200'

992 !"is i"t!ra$si o#at d!"*a" h!r#al da" supl!m!"ya"* sudah t!rdo$um!"tasi, dima"a 250 di a"tara"ya

t!rmasu$ $! dalam i"t!ra$si mayor %:sai et al, 2012'

P!"dahulua"...cont’d


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Macam I"t!ra$si -#at

;!rdasar$a" Fas! :!radi"ya I"t!ra$si

1. I"t!ra$si Fas! Farmasetik

. I"t!ra$si s!#!lum o#at masu$ dalam tu#uh

.:!r$ait (ormulasi, i"$ompati#ilitas

2. I"t!ra$si Fas! Farmakokinetik

.:!r$ait "asi# o#at di dalam tu#uh

.P!ru#aha" pada pros!s A+M<

=. I"t!ra$si Fas! Farmakodinamik.:!r$ait !(!$ o#at dalam tu#uh

.Aditi(, si"!r*isti$, a"ta*o"isti$


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I"t!ra$si Farmas!ti$

Drugs Interactant Result

>!(tria?o"! sodium @actat!d i"*!rs solutio" >aB>!(tria?o"! pr!cipitat!

+aptomyci" +!?tros! solutio" +aptomyci" pr!cipitat!

+aptomyci" 0.63 sali"! solutio"@actat!d i"*!rs solutio"

>ompati#l!

Pip!racilli"Btazo#actam AcycloCir Particl! (ormatio"

Amphot!rici" ; Flocculatio"

Mitomyci" ;lu! colour

:h!ophylli"! >!(!pim! >!(!pim! d!*rad!s up to 283

+iaz!pam PD> co"tai"!r adsorptio"

David W. Newton (2009) Am J Health-System Pharm. (!)"#!$-#%&

'hilo ertshe et al (200$) Am J Health-Syst Pharm. %(*9)"*$#!-*$!0H+,eis (*99&)


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Macam I"t!ra$si -#at

;!rdasar$a" !"is S!"ya/a ya"*

;!ri"t!ra$si

1. -#at 4 -#at

2. -#at 4 Ma$a"a"

=. -#at 4 Mi"uma"

5. -#at 4 Nutrisi

8. -#at 4 ;aha" tam#aha" dalam (ormulasi. -#at 4 P!"ya$it

. -#at 4 @i"*$u"*a"

9. -#at B 7!r#al


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I"t!ra$si -#at B -#at

I"t!ra$si pada Fas! Farmas!ti$, Farma$o$i"!ti$ da"

Farma$odi"ami$

>o"toh


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I"t!ra$si -#at B Ma$a"a"

Ma$a"a" da" o#at 4

o#ata" p!r oral

$!ro"*$o"*a" lam#u"*

@am#u"* ma$a"a" G

o#at #!rcampur

I"t!ra$si pali"* umum

ma$a"a" m!"uru"$a"

a#sor#si o#at %ada u*a

ya"* m!"i"*$at$a"'


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>o

Kaptopril G ma$a"a" $adar o#at #!r$ura"* 283

SaHui"aCir G ma$a"a" m!m#a"tu disolusi %2? lipat

di#a"di"*$a" ta"pa ma$a"a"'

Ka"du"*a" $alsium, $atio"B$atio" p!m#!"tu$a" $!lat

Ma$a"a" ti"**i Cit K #!rla/a"a" !(!$ d!"*a" /ar(ari"


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I"t!ra$si -#at B Mi"uma"

Kopi G !r*otami"

i"t!ra$si $a(!i" d!"*a"

o#at m!larut$a" o#at

l!#ih #a"ya$ s!hi"**ato$si$

Sild!"a(il %Cia*ra' G us

!ru$ %*rap!(ruit'

$adar o#at m!"i"*$at ,

m!"adi$a" s!ra"*a"

a"tu"*


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video

http://var/www/apps/conversion/tmp/scratch_6/Don't%20Take%20This%20With%20That-%20Grapefruit,%20Drug%20Interaction.flvhttp://var/www/apps/conversion/tmp/scratch_6/Don't%20Take%20This%20With%20That-%20Grapefruit,%20Drug%20Interaction.flv


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I"t!ra$si -#at B Nutrisi


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I"t!ra$si -#at 4 ;aha" tam#aha" dalam

(ormulasi

Misal"ya (!"itoi" G sacarum lactis sacarum lact

m!"i"*$at$a" $adar (!"itoi" dalam umlah #!sar

to$sisitas.

I"t!ra$si -#at 4 P!"ya$it

pasi!" d!"*a" p!"ya$it i"(!$si m!"stimulasi

sito$rom P580 s!hi"**a

m!mp!"*aruhi $adar o#at. P!"ya$it dia#!t!s hip!r*li$!mi p!ru#aha" pada

prot!i" plasma

a*al *i"al p!"uru"a" !$s$r!si o#at, p!"uru"a"

al#umi"


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I"t!ra$si -#at 4 @i"*$u"*a"

Misal"ya ro$o$, p!stisida , asap

$!"daraa" %td$ la"*su"*', $!masa"

o#at %la"*su"*'

Asap ro$o$ tim#al , mampu

m!ru#ah +NA suatu s!l , s!hi"**a

m!mp!"*aruhi $!adaa" o#at dalamtu#uh .

I"t!ra$si -#at 4 7!r#al

:r!" p!"**u"aa" h!r#al

p!"ti"*"ya medication reconciliation


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Fa$tor -#at

Indeks Terapi Sempit Formulasi Obat

i"t!ra$si dapat t!radi a"tara o#at d!"*a"

!$sipi!" & #aha" tam#aha"

o#at ya"* m!mpu"yai *u*us ald!hid a$a"#!ri"t!ra$si d!"*a" ca"*$a"* $apsul ya"*

t!r#uat dari *!lati" %t!rmasu$ prot!i"' J t!radi

r!a$si $o"d!"sasi

Stereokimia

;!"tu$ SBar(ari" l!#ih lam#at dim!ta#olism!

di#a"di"*$a" #!"tu$


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Potensi Obat

-#at pot!" #ila umlah s!di$it sudah m!m#!ri$a"

!(!$. ;ila t!radi i"t!ra$si o#at ma$a a$a" t!radi !(!$

ya"* si*"i(i$a"

Durasi Terapi

misal"ya i"du$si !"zim ya"* m!m#!ri$a" /a$tulama

MA-I o"s!t 2 mi"**u , optimal s!$itar 1 #ula" ,

$!mudia" i$a di*a"ti d!"*a" o#at lai" , misal

a"tid!pr!sa" ma$a MA-I dih!"ti$a" dulu sampai 2

mi"**u #aru m!"**u"a$a" o#at a"tid!pr!sa". Dosis Obat

S!ma$i" #!sar dosis, #iasa"ya i"t!ra$si ya"* t!radi

l!#ih i"t!"s.


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Waktu & Urutan Penggunaan Obat

Misal"ya cipro(o$sasi" d!"*a" a"tasida

i$a dimi"um #!rsamaa" P!"uru"a" a#sor#si

a"ti#ioti$

Ma"a!m!"E Ya"* ma"a dulua"E

Rute Administrasi


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etabolisme Obat

s!ma$i" #a"ya$ ya"* dim!ta#olism! ma$a umlah ya"*

a$ti( a$a" s!ma$i" s!di$it&$!cil.

Protein-binding

ar(ari" t!ri$at $uat dalam plasma, i$a did!sa$ dari

i$ata""ya

r!si$o p!"daraha". P!"ya$it *i"al produ$si al#umi" #!r$ura"*

!olume distribusi

Dolum! distri#usi $!cil $adar o#at dalam darah

#!sar, s!hi"**a r!si$o i"t!ra$si s!ma$i" #!sar.

Dolum! distri#usi #!sar $adar o#at dalam darah

$!cil, da" o#at #a"ya$ masu$ $! or*a" 4 or*a"

p!ri(!r


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Fa$tor Pasi!"

"erat "adan

Misal pada o#at "!oplasti$ %o#at $a"$!r' P!"*u$ura"

m!"**u"a$a" ti"**i #ada" da" ;;

#enetik Polimor$isme

Polimor(ism! #a"ya$ s!di$it"ya !"zim

p!m!ta#olism! o#at

+alam m!ta#olism! o#at, ada ora"* as!tilator c!pat

da" as!tilator lam#at

Perbedaan Individual

p!"**u"aa" pada pa*i hari #!r#!da d!"*a" padamalam hari %ritm! sir$adia"' produ$si 7>l

lam#u"*, p!"**u"aa" stati"


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Umur

Utama"ya pada *!riatri$ da" p!diatri$

#ender

-#at ya"* m!m#lo$ r!s!ptor L #!rl!#iha" a$a"

#!rp!"*aruh pada pria ya$"i !r!$si ya"* #!rl!#iha"

da" m!"ya$it$a".

Ras

m!mp!rpa"a"* r!spo" (arma$olo*i ora"*

ora"* Am!ri$a turu"a" "!*ro l!#ih mudah t!radi

$!"ai$a" t!$a"a" darah di#a"di"*$a" d!"*a"$ulit putih.


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#a%a idup

P!"*aruh to#acco

m!ro$o$ dapat

m!"y!#a#$a" i"du$si

m!ta#olism! o#at

$husus"ya sito$rom P580

Al$ohol A$ut %i"hi#isi' CsKro"is %i"du$si'

Diet

Asupa" prot!i" p!m#!"tu$a"

!"zim ) prot!i" plasma

Fungsi organ pengeliminasi

mal(u"*si *i"al /a$tu

cl!ara"c! o#at


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Fa$tor @ai""ya

1 -#at #!#!rapa !(!$

1 do$t!r

S/am!di$asi ya"* $ura"* t!r$o"trol

P!"yalah*u"aa" o#at


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Si*"i(i$a"si i"t!ra$si

P!rta"yaa" ya"* p!rlu dita"ya$a"

Apa ya"* t!radi saat o#at A da" o#at ; di#!ri$a" s!cara

#!rsamaa"E

Kapa" i"t!ra$si t!radiE S!cara c!pat&la"*su"* atau s!la"*

#!#!rapa lamaE impli$asiEE

;a*aima"a $!paraha" dampa$ i"t!ra$siE

Time frame?

P!rlu a$si atau tida$E


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P!ru#aha" (arma$o$i"!ti$ (arma$odi"ami$

Clinically important (arma$odi"ami$ !(i$asi

) to$sisitas

I"t!ra$si pot!"sial Cs i"t!ra$si a$tual

si*"i(i$a"si

Clinically unimportant

Clinically important


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!(!r!"c!

1. KodaBKim#l! MA ) You"* @Y %1669' 7a"st!" a"d 7or"Os Ma"a*i"*

>li"ically Importa"t +ru* I"t!ractio"s, Appli!d :h!rap!utics, I"c,

Da"couC!r

2. KodaBKim#l! !t al %200' 7a"d#oo$ o( Appli!d :h!rap!utics, 9th !d,

@ippi"cott illiams ) il$i"s, Philad!lphia

=. Mozaya"i A ) aymo" @P %2005' 7a"d#oo$ o( +ru* I"t!ractio"sB A

>li"ical a"d For!"sic uid!, 7uma"a Pr!ss, N!/ !rs!y

5. odri*u!s A+ %2002' +ru*B+ru* I"t!ractio"s, :aylor ) Fra"cis, N!/ Yor$

8. Stoc$l!y I7 %1665' +ru* I"t!ractio"s, =rd !d, ;lac$/!ll Sci!"c!, @o"do"


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A"y Hu!stio"sEE


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“Some are born great some ac!ie"e

greatness some !a"e greatness t!rust upon

t!em#

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