laporan kasus hz oticus

7/24/2019 Laporan Kasus HZ Oticus

1/18

HERPES ZOSTER OTICUS DENGAN KELEMAHAN SARAF FACIAL:

LAPORAN KASUS

Utomo TK1, Suswara!a"

1Do#t$r Mua Fa#u%tas K$o#t$ra! Tr&sa#t& &

SMF I%mu K$s$'ata! Ku%&t a! K$%am&! RSAL r( M&!to'ar)o

"SMF I%mu K$s$'ata! Ku%&t a! K$%am&! RSAL r( M&!to'ar)o

ABSTRAK

H$r*$s +ost$r, )ua $!a% s$-aa& '$r*$s +ost$r atau +ost$r, aa%a' &!.$#s& /Z/ &a#t&.#a!

ar& a!%&o! sara. s$!sor a! sara. *$r&.$r a! 0a-a!0a-a!!2a( P$raa!a! 'as&% a#so!

sara. & m$!2a#&t#a!, s$!sas& t$r-a#ar *aa $rmatom 2a! t$r#$!a 3s4 2a! &s$&a#a! o%$'

sara. *$r&.$r( L$tusa! 5$su%ar *aa #u%&t ar& $rmatom 2a! t$r%&-at )ua 'a&r( Paa #asus

&!& & -a'as *$!o-ata! %$s& 2a! m$!a#&-at#a! #$%$ma'a! sara. .a0&a%&s(

PENDAHULUAN

/ar&0$%%a +ost$r 5&rus 3/Z/4 -$rta!u! )awa- u!tu# ua *$!2a#&t #%&!&s 2a! -$r-$a(

P$rtama *a*ara! /Z/ -&asa!2a t$r)a& *aa masa #a!a##a!a# a! m$!2$-a-#a! *$!2a#&t

5ar&0$%%a(

S$t$%a' *$mu%&'a!, 5&rus t$ta* a#t&. & a!%&a s$!sor&s a! s$#&tar 678 ar&


2/18

#asus &tu a#a! m$!a#t&.#a! #$m-a%& & #$mu&a! 'ar&, m$!2$-a-#a! '$r*$s +ost$r 3HZ4,

s$-ua' &!.%amas&

*$!2a#&t #u%&t 2a! -$r'u-u!a! $!a! mor-&&tas 2a! %$-&' s$r&us( S$#&tar 1 )uta

#asus '$r*$s +ost$r t$r)a& & AS s$t&a* ta'u!!2a, $!a! t&!#at #$)a&a! & s$mua

#$%om*o# us&a 1,"9, #asus *$r 1(777 ora! *$r ta'u!

H$r*$s +ost$r %$-&' umum t$r)a& *aa *as&$! -$r#u%&t *ut&' 3#$)a&a! 6;8 %$-&' t&!& ar&

*aa *as&$! #u%&t '&tam4, *as&$! us&a %a!)ut 3#$)a&a! 6< #a%& %$-&' t&!& &-a!&!#a!

*o*u%as& umum4, a! *as&$! &mmu!o0om*rom&s$ 3#$)a&a! "7 #a%& %$-&' t&!&

&-a!&!#a! *aa *as&$! &mu!o#om*$t$!4

=$-$ra*a *$!$%&t&a! m$%a*or#a! &!s&$! 2a! %$-&' t&!& *aa wa!&ta 36, #asus *$r 1(777

ora!ta'u! 5s ",> #asus *$r 1(777 ora!ta'u! & a!tara %a#&%a#&4

P$!2$-a- a! .a#tor r&so

P$!2$-a-

A$! *$!2$-a- '$r*$s +ost$r, /Z/, aa%a' %&!$ar, asam $o#s&r&-o!u#%$at u!ta& a!a

3DNA4 $!om t$rtutu* a%am am*%o* *rot$&!( S$t$%a' *$rtaru!a! *$!2a#&t $!a! &!.$#s&

*r&m$r 30a0ar4, 5&rus t$rt&ur & a!%&o! sara. s$!sor sam*a& &a#t&.#a! #$m-a%&( Pros$s

*$!a#t&.a! t&a# s$*$!u'!2a &*a'am&, t$ta*& -$-$ra*a .a#tor r&so 2a! t$r#a&t t$r0a!tum

& -awa' &!&(

Fa#tor r&so

Us&a %a!)ut 3%$-&' tua *as&$!, s$ma#&! t&!& r&so4


3/18

Paa *as&$! us&a %a!)ut atau #$ta &mu!&tas s$%u%$r m$!)a& t$ra!u, t&!#at .u!s& T0$%%

m$!uru! sam*a& turu! & -awa' am-a! -atas 2a! t$r#a&t $!a! *$!a'a!a! 2a! t&a#

m$maa& ar& /Z/ r$a#t&5as& a! *$r#$m-a!a! s$%a!)ut!2a ar& '$r*$s +ost$r(

Immu!o0om*rom&s$ #ar$!a *$!2a#&t atau *$!u!aa! o-at &mu!osu*r$s&.

Ka!#$r, 'uma! &mmu!o$.&0&$!02 5&rus 3HI/4, ora! atau tra!s*%a!tas& sumsum tu%a!, a!

asu*a! #ro!&s o-at &mu!osu*r$s&. m$m*$!aru'& *as&$! u!tu# m$m&%& &mu!&tas 2a!

&*$ra!tara& s$% m&s#&! a!, $!a! $m&a!, m$!$m-a!#a! '$r*$s +ost$r

Pas&$! &mmu!o0om*rom&s$ aa%a' "7 #a%& %$-&' mu!#&! u!tu# m$!$m-a!#a! '$r*$s

+ost$r &-a!&!#a! *as&$! &mu!o#om*$t$!( M$r$#a )ua %$-&' 0$!$ru! m$m&%&

#$t$r%&-ata! %$-&' m$!2$-ar, %$s& #u%&t 2a! *ara', *$!&!#ata! #$*ara'a! a! uras& !2$r&,

a! ma!&.$stas& at&*a%

Str$s $mos&o!a% a! *so%o&s

Str$s $mos&o!a%, s$*$rt& #$mat&a!, mu!#&! t$r#a&t $!a! *$r#$m-a!a! '$r*$s +ost$r

a%am wa#tu > -u%a! s$t$%a' *$r&st&wa #$'&u*a! 2a! *$!u' str$s

Str$s )a!#a *a!)a! a*at m$!u-a' s&st$m #$#$-a%a! tu-u', a! &mu!&tas s$%u%$r s*$s&.

/Z/ 2a! %$-&' r$!a' & a!tara ora! $wasa $!a! $*r$s& -$rat


4/18

T&!a#a! *$!0$a'a!

H$r*$s +ost$r 5&rus 5a#s&! &-$ra! u!tu# m$!&!#at#a! )um%a' s$%T5ar&0$%%a s*$s&. a!,

$!a! $m&a!, m$!0$a' '$r*$s +ost$r *aa *as&$! 2a! t$%a' m$!$r&ta 0a0ar a&r atau

t$%a' &5a#s&!as& t$r'aa* 0a0ar s$-$%um!2a

S$*$rt& 5a#s&! 5ar&0$%%a, 5a#s&! '$r*$s +ost$r aa%a' 5a#s&! '&u*( /&rus stra&! 2a! sama

&u!a#a! u!tu# #$ua 5ar&0$%%a a! '$r*$s +ost$r 5a#s&!, !amu! 5a#s&! '$r*$s +ost$r

m$m&%& *ot$!s& 2a! %$-&' t&!& a! #om*o!$! a!t&$! tam-a'a! ar& !o!5&a-%$ O#a ?

M$r0# /Z/

/a#s&! '$r*$s +ost$r &tu!)u##a! *aa ora! $wasa s$'at -$rus&a >7 ta'u! a! %$-&' tua

Ha% &!& t&a# *$r%u u!tu# m$!a*at#a! r&wa2at 0a0ar 35ar&0$%%a atau a!t&-o& t&!#at4 *aa

*as&$! 2a! 5a#s&! &tu!)u##a!

/a#s&! &!& #o!tra&!as& *aa *o*u%as& -$rut:

Pas&$! $!a! r&wa2at r$a#s& a%$r& t$r'aa* #om*o!$! 5a#s&!

Pas&$! s$a! m$!$r&ma t$ra*& &mu!osu*r$s&. s&st$m 3m&sa%!2a, t$ra*& #ortost$ro&

)a!#a *a!)a!, mou%ator &mu!4

Pas&$! 2a! m$!)a%a!& tra!s*%a!tas& s$% &!u# '$mato*o&$t 3sam*a& *$mu%&'a! .u!s&

#$#$-a%a! tu-u' a! t&a# s$-$%um "9 -u%a! s$t$%a' tra!s*%a!tas&4

Pas&$! $!a! #$a!asa! 2a! m$%&-at#a! sumsum tu%a! atau s&st$m %&m.at 3m&sa%!2a

%&m.oma4, #$0ua%& a%am r$m&s& a! m&!&ma% 6 -u%a! t$%a' -$r%a%u s$)a# #$mot$ra*& atau

t$ra*& ra&as&


5/18

Pas&$! $!a! a0@u&r$ &mmu!o$.&0&$!02 s2!rom$ 3AIDS4 atau *as&$! HI/*os&t&. $!a!

)um%a' CD9 "77 ? uL

Pas&$! $!a! -$!tu# &!tr&!s atau &*$ro%$' %a&! &mmu!o$.&0&$!02 s$%u%$r

Pas&$! 2a! m$!$r&ma t$ra*& a!t&5&rus

S$-ua' os&s tu!a% 5a#s&! '$r*$s +ost$r m$!ura!& r&so m$!$m-a!#a! '$r*$s +ost$r

s$t$!a', m$!ura!& #$*ara'a! a! uras& *$!2a#&t, a! m$!0$a' #om*%as& *aa s$#&tar

ua *$rt&a ar& #asus( E.$# *$r%&!u!a! -$r%a!su! s$%ama m&!&ma% 6 ta'u! s$t$%a'

5a#s&!as&

E.$# sam*&! %o#a% s$t$%a' 5a#s&!as& t$rmasu# $r&t$ma, !2$r&, *$m-$!#a#a!, a! ata% &

t$m*at su!ta!, 2a! t$r)a& *aa 9,68 ar& *$!$r&ma 5a#s&!( S$#&tar >,68 ar& *as&$!

2a! &5a#s&!as& *$!a%ama! sa#&t #$*a%a

LAPORAN KASUS

S$ora! Ma'as&sw& -$rumur 1 ta'u! ata! #$ *o%& D/ RSAL M&!to'ar)o $!a! #$%u'a!

N2$r& t$%&!a s$-$%a' #&r&( N2$r& t$%&!a t$r)a& s$)a# 1 m&!u 2a! %a%u, #$%u'a! t$r)a&

s$0ara *$r%a'a! & awa%& o%$' !2$r& #$*a%a s$)a# " m&!u SMRS, #$%u'a! !2$r& #$*a%a

'&%a! t&m-u% a! %$-&' s$r&! '&%a! -&%a & -awa t&ur, N2$r& t$%&!a t$r)a& t$rus m$!$rus

a! #aa! t$rasa sa!at !2$r& s$#a%& 2a! -&sa t$r)a& %$-&' ar& ; B a%am s$'ar&, a! !2$r&

t&a# & *$r-$rat a%am *os&s& t$rt$!tu, !2$r& -$rs&.at s$*$rt& & tusu#tusu#, !2$r& t$%&!a

-$r#$m-a! *ror$ss&5$ %$-&' -$rat s$)a# ar& awa%!2a t&m-u% #$%u'a! a! a#'&ra#'&r &!&

t$rasa amat !2$r&, *as&$! )ua m$!$r&ta $mam 6 'ar& SMRS a! a#'&r!2a t&m-u% #$%u'a!

-&!t&% -$r&s& a&r & t$%&!a " 'ar& -$rut!2a( K$%u'a! &!& t$r)a& *aa saat *as&$! #$%$%a'a!


6/18

*aa os*$# & #am*us!2a 2a! t$r)a& #ura! %$-&' " m&!u SMRS s$-$%um t&m-u%!2a

#$%u'a! !2$r& #$*a%a, N2$r& Otot 34, L$mas 34(

Pas&$! t&a# m$m&%& r&wa2at a%$r&, s$%ama " m&!u t&m-u%!2a #$%u'a! !2$r&

#$*a%a *as&$! sua' -$ro-at #$ 6 o#t$r umum a! m$!a*at#a! o-at a!t&-&ot&0 t$ta*& t&a#

aa *$r-aa!, s$-$%um!2a *as&$! t&a# *$r!a' m$!$r&ta 'a% s$*$rt& &!& , *as&$! t&a# *$r!a'

m$!)a%a!#a! o*$ras& a! *as&$! -$%um *$r!a' & rawat & ruma' sa#&t(

K$%uara t&a# aa 2a! m$!$r&ta 'a% 2a! sama, t$ta*& sa%a' satu t$ma! #am*us!2a

aa 2a! m$!$r&ta *$!2a#&t 2a! sama, a! *as&$! m$!0ur&a& #a%au t$rtu%ar ar& t$ma!!2a

&tu(

Gam-ar 1( Gam-ara! %$s& #u%&t *as&$! !a #$%$ma'a! sara. .a0&a%(


7/18

PEMBAHASAN

P$!o-ata! H$r*$s Zost$r

P$!o-ata! '$r*$s +ost$r m$m&%& t&a tu)ua! utama: 314 *$!o-ata! &!.$#s& 5&rus a#ut, 3"4

*$!o-ata! !2$r& a#ut -$r'u-u!a! $!a! '$r*$s +ost$r a! 364 *$!0$a'a! *ost'$r*$t&0

!$ura%&a( A$! a!t&5&rus, #ortost$ro& ora% a! a)u5a! &!&5&ua% moa%&tas !2$r&

ma!a)$m$! 2a! &u!a#a! u!tu# m$!0a*a& tu)ua! t$rs$-ut(

A!t&5&rus

A!t&5&rus t$%a' t$r-u#t& m$!uru!#a! uras& '$r*$s +ost$r ruam a! t&!#at #$*ara'a! rasa

sa#&t 2a! t$r#a&t $!a! ras'(1" Namu!, ma!.aat &!& 'a!2a t$%a' &tu!)u##a! *aa *as&$!

2a! m$!$r&ma o-at a!t&5&rus a%am wa#tu


8/18

As%o5&r, o-at *rotot&*$ a!t&5&rus, aa%a' &!'&-&tor DNA *o%&m$ras$( A020%o5&r a*at

&-$ra! s$0ara ora% atau &!tra5$!a( K$%$ma'a! utama ar& ora% as%o5&r t$rmasu#

-&oa5a&%a-&%&tas 2a! %$-&' r$!a' &-a!&!#a! $!a! a$! %a&!!2a a! .r$#u$!s& os&s !2a

3%&ma #a%& s$'ar&4( I!tra5$!a as%o5&r umum!2a &u!a#a! 'a!2a *aa *as&$! 2a! *ara'

&mmu!o0om*rom&s$ atau 2a! t&a# mam*u u!tu# m$!am-&% o-at ora%(

/a%a020%o5&r, *roru ar& as%o5&r, &-$ra! t&a #a%& s$'ar&( D&-a!&!#a! $!a!

a020%o5&r, 5a%a020%o5&r mu!#&! s$&t %$-&' -a *aa *$!uru!a! t&!#at #$*ara'a! rasa

sa#&t 2a! t$r#a&t $!a! '$r*$s +ost$r, s$rta uras& !$ura%&a(19 *ost'$r*$t&0 /a%a020%o5&r

)ua %$-&' -&oa5a&%a-%$ ar&*aa as%o5&r, a! ora% m$!'as&%#a! t&!#at o-at ara'

s$-a!&! $!a! *$m-$r&a! &!tra5$!a as%o5&r(

Fams%o5&r )ua &!'&-&tor DNA *o%&m$ras$( K$u!tu!a! ar& .am0&0%o5&r )awa% *$m-$r&a!

os&s 2a! 3t&a #a%& s$'ar&4, %a& &!tras$%u%$r *aru' &-a!&!#a! $!a! as%o5&r a!

-&oa5a&%a-&%&tas 2a! %$-&' -a &-a!&!#a! $!a! a020%o5&r a! 5a%a020%o5&r(

P&%&'a! 2a! a!t&5&ra% a$! u!tu# &u!a#a! aa%a' &!&5&ua%( awa% os&s a! -&a2a

mu!#&! *$rt&m-a!a!( Dos&s 2a! &a!)ur#a! u!tu# as%o5&r, .ams%o5&r a! 5a%as%o5&r

&s$&a#a! *aa Ta-$% 1( S$mua t&a a$! a!t&5&rus 2a! a*at &to%$ra!s& $!a! -a( E.$#

sam*&! 2a! *a%&! umum aa%a' mua%, sa#&t #$*a%a, mu!ta'mu!ta', *us&! a! sa#&t

*$rut(


9/18

Treatment Options for Herpes Zoster

MEDICATION DOSAGE AVERAGE COST (GENERIC)*

Acyclovir

(Zovirax)

800 mg orally five times daily for 7 to 10

days 10 mg per g !" every 8 #o$rs for 7 to

10 days%

&17' to '8 (1 to 00)

*amciclovir

(*amvir)

+00 mg orally t#ree times daily for 7 days 1'0

"alacyclovir

("altrex)

1,000 mg orally t#ree times daily for 7 days 8'

-rednisone

(.eltasone)

/0 mg orally tice daily on days 1 t#ro$g# 7

t#en 1+ mg tice daily on days 8 t#ro$g# 1'

t#en 72+ mg tice daily on days 1+ t#ro$g#

1

( to ') for days 1 t#ro$g# 7

(1 to /) for days 8 t#ro$g# 1' 1

(1 to ) for days 1+ to 1

IV = intravenously2

*Estimated cost to the pharmacist based on average wholesale prices (rounded to the nearest dollar), for

seven days of therapy, in ed boo!" #ontvale, $"%"& #edical Economics 'ata, " ost to the patient will

be higher, depending on prescription filling fee2

+ntiviral therapy has been shown to be beneficial only when patients are treated within - hours of onset

of the herpes .oster rash" ntiviral agents are not used in combination, and selection of an agent is based on

dosage schedule and cost2

/cyclovir can be administered IV to severely immunocompromised patients or patients who are unable to

ta!e medications orally2

Kortost$ro&

Kortost$ro& ora% 2a! umum &u!a#a! a%am *$!o-ata! '$r*$s +ost$r, m$s#&*u! u)&

#%&!&s t$%a' m$!u!)u##a! 'as&% 5ar&a-$%( Pr$!&so! &u!a#a! -$rsama $!a! as%o5&r t$%a'


10/18

t$r-u#t& m$!ura!& rasa sa#&t 2a! t$r#a&t $!a! '$r*$s +ost$r(1; M$#a!&sm$ #$mu!#&!a!

m$%&-at#a! *$!uru!a! t&!#at !$ur&t&s 2a! &s$-a-#a! o%$' &!.$#s& a#t&. a!, mu!#&!,

*$!uru!a! #$rusa#a! s&sa sara. 2a! t$r#$!a(

=$-$ra*a stu& 2a! &ra!0a! u!tu# m$!$5a%uas& $.$#t&5&tas t$ra*& *r$!&so! a%am

m$!0$a' !$ura%&a *ost'$r*$t&0 t$%a' m$!u!)u##a! *$!uru!a! !2$r& *aa t&a a! 1"

mo!t's(1>,1< P$!$%&t&a! %a&! t$%a' m$!u!)u##a! t&a# aa -$!$.&t(1;,1

a *$!u!aa! ora% *r$!&so!$ t&a# #o!tra&!as&, t$ra*& tam-a'a! $!a! a$! &!&

&-$!ar#a! atas asar am*a#!2a a%am m$!ura!& rasa sa#&t, m$s#&*u! -u#t&-u#t&

&*$rta!2a#a! #ar$!a ma!.aat!2a a%am m$!ura!& #$)a&a! *ost'$r*$t&0 !$ura%&a(

M$!&!at r&so t$or&t&s &mu!osu*r$s& $!a! #ortost$ro&, -$-$ra*a *$!$%&t& *$r0a2a

-a'wa a$! &!& 'arus &u!a#a! 'a!2a *aa *as&$! %$-&' ar& ;7 ta'u! #ar$!a m$r$#a -$raa

*aa r&so %$-&' -$sar t$r#$!a !$ura%&a(1; *ost'$r*$t&0 Dos&s 2a! &a!)ur#a! u!tu#

*r$!&so! &-$ra! *aa Ta-$% 1(

ANALGESIK

Rasa sa#&t 2a! t$r#a&t $!a! '$r*$s +ost$r -$r#&sar ar& r&!a! sam*a& m$!2sa( Pas&$!

$!a! !2$r& r&!a! sam*a& s$a! a*at m$!a!a*& o5$rt'$0ou!t$r a!a%$s( Pas&$!

$!a! !2$r& 2a! %$-&' *ara' mu!#&! m$m$r%u#a! *$!am-a'a! o-at !ar#ota( K$ta

a!a%$s &u!a#a!, $!a! atau ta!*a !ar#ota, -&asa 'as&% )awa% *$m-$r&a! os&s &

#o!tro% !2$r& 2a! %$-&' -a a! #$0$masa! #ura! ar& s$-aa& &-utu'#a! os&s(


11/18

Lot&o! 2a! m$!a!u! 0a%am&!$ 3m&sa%!2a Ca%ar2%4 a*at &u!a#a! *aa %$s& t$r-u#a

u!tu# m$!ura!& rasa sa#&t a! *rur&tus( S$t$%a' %$s& t$%a' -$r#u%&t %$-&', 0a*sa&0&! #r&m

3Zostr&B4 a*at &t$ra*#a!( To*a% &-$ra! %&o#a&! 32%o0a&!$4 a! sara. -%o# )ua t$%a'

&%a*or#a! $.$#t&. a%am m$!ura!& rasa sa#&t(

KETERLI=ATAN OCULAR

O#u%ar '$r*$s +ost$r &*$r%a#u#a! $!a! a$! ora% a!t&5&rus a! #ortost$ro&, sama s$*$rt&

#$t$r%&-ata! t$m*at %a&!( M$s#&*u! s$-a&a! -$sar *as&$! $!a! '$r*$s +ost$r o#u%ar

m$!&!#at#a! ta!*a $)a%a s&sa 2a! -$r%a!su!, -$-$ra*a mu!#&! m$!a%am& #om*%as&

*ara', t$rmasu# #$'&%a!a! *$!%&'ata!( K$ta '$r*$s +ost$r m$%&-at#a! mata, #o!su%tas&

o*ta%mo%o& -&asa!2a &a!)ur#a!(

PENGO=ATAN PENCEGAHAN

Mor-&&tas a! morta%&tas ar& '$r*$s +ost$r a*at ura!& )a *$!o-ata! *$!0$a'a!

2a! ama! a! $.$#t&. 2a! t$rs$&a( Ha% &!& -&asa -a& s$ora! *as&$! u!tu#

m$!$m-a!#a! '$r*$s +ost$r %$-&' ar& s$#a%&, m$!u!)u##a! -a'wa r$a#t&5as& *$rtama

5&rus 5ar&0$%%a+ost$r -&asa!2a m$m-$ra! *$r%&!u!a! #$#$-a%a! masa $*a!( Stu& saat

&!& s$a! &%a#u#a! u!tu# m$!$5a%uas& $.$#t&5&tas 5a#s&! 5ar&0$%%a+ost$r a%am m$!0$a'

atau m$mo&.as& '$r*$s +ost$r *aa ora! tua(

P$!o-ata! Post'$r*$t&0 N$ura%&a


12/18

M$s#&*u! !$ura%&a *ost'$r*$t&0 umum!2a #o!&s& &r& t$r-atas, -&sa -$rta'a! s$%ama!2a(

P$!o-ata! &ara'#a! *aa #o!tro% !2$r& sam-&% m$!u!u #o!&s& u!tu# m$!2$%$saa!(

T$ra*& !2$r& a*at m$!0a#u* -$-$ra*a &!t$r5$!s&, s$*$rt& o-at to*a%, o5$rt'$0ou!t$r

a!a%$s, a!t&$*r$sa! tr&s%, a!to!5u%sa! a! s$)um%a' moa%&tas !o!m$&s( Kaa!

#aa!, !ar#ota mu!#&! &*$r%u#a!( R$#om$!as& os&s &-$ra! *aa Ta-$% "

Treatment Options for -ost#erpetic 3e$ralgia4

MEDICATION DOSAGE

Topical agents

5apsaicin cream

(Zostrix)

Apply to affected area t#ree to five times daily2

6idocaine

(ylocaine) patc#

Apply to affected area every ' to 1 #o$rs as needed2

Tricyclic antidepressants

Amitriptyline (lavil) 10 to + mg orally at 9edtime increase dosage 9y + mg every to ' ees

$ntil response is ade:$ate, or to maxim$m dosage of 1+0 mg per day2

3ortriptyline

(-amelor)

10 to + mg orally at 9edtime increase dosage 9y + mg every to ' ees

$ntil response is ade:$ate, or to maxim$m dosage of 1+ mg per day2

!mipramine

(Tofranil)

+ mg orally at 9edtime increase dosage 9y + mg every to ' ees $ntil

response is ade:$ate, or to maxim$m dosage of 1+0 mg per day2


13/18

MEDICATION DOSAGE

.esipramine

(3orpramin)

+ mg orally at 9edtime increase dosage 9y + mg every to ' ees $ntil

response is ade:$ate, or to maxim$m dosage of 1+0 mg per day2

Anticonv$lsants

-#enytoin (.ilantin) 100 to /00 mg orally at 9edtime increase dosage $ntil response is ade:$ate

or 9lood dr$g level is 10 to 0 ;g per m6 ('0 to 80 ;mol per 6)2

5ar9ama


14/18

Su-sta!s& P, s$-ua' !$uro*$*t&a &%$*as#a! ar& s$rat !2$r& a%am m$!a!a*& trauma, )ua

&%$*as#a! #$ta 0a*sa&0&! &t$ra*#a! *aa #u%&t, m$!'as&%#a! s$!sas& t$r-a#ar( A!a%$s&a

t$r)a& #$ta +at P 'a-&s ar& s$ra-ut sara.( U!tu# m$!0a*a& r$s*o! &!&, 0a*sa&0&! #r&m 'arus

&t$ra*#a! u!tu# a$ra' 2a! t$r#$!a 6; #a%& s$'ar&( Pas&$! 'arus #o!s$%&! t$!ta!

#$-utu'a! u!tu# m$!$ra*#a! 0a*sa&0&! s$0ara rut&! u!tu# #$*$!t&!a! %a!)uta!( M$r$#a )ua

*$r%u &-$r& #o!s$%&! -a'wa rasa sa#&t m$r$#a #$mu!#&!a! a#a! m$!&!#at s$%ama

-$-$ra*a 'ar& *$rtama sam*a& s$m&!u s$t$%a' t$ra*& 0a*sa&0&! &mu%a&( Pas&$! 'arus

m$!0u0& ta!a! m$r$#a s$0ara m$!2$%uru' s$t$%a' m$!$ra*#a! 0a*sa&0&! 0r$am u!tu#

m$!0$a' #o!ta# t&a# &s$!a)a $!a! a$ra' %a&!(

Pat0' 2a! m$!a!u! %&o#a&! )ua t$%a' &u!a#a! u!tu# m$!o-at& !$ura%&a

*ost'$r*$t&0( Satu stu& m$!$mu#a! -a'wa &-a!&!#a! $!a! ta!*a *$!o-ata!, *at0'

%&o#a&! m$!ura!& &!t$!s&tas !2$r&, $!a! *$!2$ra*a! s&st$m 2a! m&!&ma%( M$s#&*u!

%&o0a&!$ aa%a' -$r#'as&at a%am m$!ura!& rasa sa#&t, $.$#!2a s$m$!tara, 'a!2a

-$r%a!su! $m*at sam*a& 1" )am $!a! mas&!mas&! a**%&0at&o!("1

O5$rt'$0ou!t$r a!a%$s s$*$rt& a0$tam&!o*'$! 3m&sa%!2a, T2%$!o%4 a! o-at a!t&

&!.%amas& !o!st$ro& -$%um t$r-u#t& sa!at $.$#t&. a%am *$!o-ata! *as0a'$r*$s !$ura%&a(

Namu!, a$! &!& s$r&! -$ru!a u!tu# *ot$!t&at&! $.$# *$!'&%a! rasa sa#&t !ar#ota *aa

*as&$! $!a! sa#&t *ara'( Kar$!a s&.at at&. !ar#ota, *$!u!aa! #ro!&s m$r$#a t&a#

&sara!#a! #$0ua%& *aa *as&$! %a!#a 2a! t&a# m$maa& m$!a!a*& moa%&tas %a&!!2a(

A!t&$*r$sa! tr&s%


15/18

A!t&$*r$sa! tr&s% a*at tam-a'a! -$rart& $.$#t&. a%am m$!ura!& !2$r& !$uro*at

!$ura%&a *ost'$r*$t( A$! &!& #$mu!#&!a! -$sar m$!ura!& rasa sa#&t $!a!

m$!'am-at r$u*ta#$ s$roto!&! a! !or$*&!$.r&! !$urotra!sm&tt$rs(""

A!t&$*r$sa! tr&s% 2a! umum &u!a#a! a%am *$!o-ata! !$ura%&a *ost'$r*$t&0

t$rmasu# am&tr&*t2%&!$ 3E%a5&%4, !ortr&*t2%&!$ 3Pam$%or4, &m&*ram&!$ 3To.ra!&%4 a!

$s&*ram&!$ 3Nor*ram&!4( O-at &!& &to%$ra!s& t$r-a #$ta m$r$#a mu%a& a%am os&s

r$!a' a! &-$ra! *aa wa#tu t&ur( Dos&s m$!&!#at s$t&a* ua sam*a& $m*at m&!u

u!tu# m$!0a*a& os&s $.$#t&.(

A!t&$*r$sa! tr&s% -$r-a& $.$# sam*&! 2a! umum, s$*$rt& s$as&, mu%ut #$r&!,

'&*ot$!s& *ostura%, *$!%&'ata! #a-ur a! r$t$!s& ur&!( Nortr&*t2%&!$ a! am&tr&*t2%&!$

tam*a#!2a m$m&%& #'as&at 2a! sama Namu!, !ortr&*t2%&!$ 0$!$ru! m$!'as&%#a! $.$#

a!to%&!$r %$-&' s$&t a! #ar$!a &tu %$-&' -a &to%$ra!s&( P$!o-ata! $!a!

a!t&$*r$sa! tr&s% #aa!#aa! a*at m$!2$-a-#a! #$%a&!a! #o!u#s& )a!tu! atau

to#s&s&tas 'at&( Pot$!s& masa%a' &!& 'arus &*$rt&m-a!#a! *aa *as&$! us&a %a!)ut a! *as&$!

$!a! *$!2a#&t )a!tu! atau 'at&(

Kar$!a a!t&$*r$sa! tr&s% t&a# -$rt&!a# 0$*at, *$r0o-aa! #%&!&s ar& s$t&a#!2a t&a

-u%a! &*$r%u#a! u!tu# m$!&%a& r$s*o! *as&$!( T&m-u%!2a !2$r& m$!u!a#a! a!t&$*r$sa!

tr&s% a*at &t&!#at#a! $!a! m$mu%a& *$!o-ata! awa% *$r)a%a!a! &!.$#s& '$r*$s +ost$r

a%am 'u-u!a!!2a $!a! m$&0at&o!s("7 a!t&5&rus


16/18

A!to!5u%sa!

F$!&to&! 3D&%a!t&!4, 0ar-ama+$*&!$ 3T$r$to%4 a! a-a*$!t&! 3N$uro!t&!4 s$r&! &u!a#a!

u!tu# m$!o!tro% !2$r& !$uro*at( S$-ua' ou-%$-%&!, *%a0$-o0o!tro%%$ -aru-aru &!&

m$!u!)u##a! a-a*$!t&! $.$#t&. a%am m$!o-at& rasa sa#&t !$ura%&a *ost'$r*$t, s$rta

&stur-a!0$("6 t&ur s$r&! a&t#a!

A!to!5u%sa! tam*a# samasama $.$#t&., a! *$m&%&'a! o-at s$r&! m$%&-at#a! tr&a% a!

$rror( Kura!!2a r$s*o! #$ sa%a' satu o-ato-at &!& t&a# s$%a%u m$rama%#a! r$s*o! 2a!

-uru# #$ 2a! %a&!( Dos&s 2a! &*$r%u#a! u!tu# a!a%$s&a s$r&!#a%& %$-&' r$!a' ar&*aa

2a! &u!a#a! a%am *$!o-ata! $*&%$*s&(

A!to!5u%sa! -$r'u-u!a! $!a! -$r-aa& $.$# sam*&!, t$rmasu# s$as&, a!ua!

m$mor&, #$%a&!a! $%$#tro%&t, to#s&s&tas 'at& a! trom-os&to*$!&a( E.$# sam*&! a*at

ura!& atau &'&%a!#a! $!a! m$mu%a& *$!o-ata! a%am os&s r$!a', 2a! #$mu&a!

a*at *$r%a'a! &t&tras& #$ atas(

T&a# aa #o!tra&!as& #'usus u!tu# m$!u!a#a! a!to!5u%sa! a%am #om-&!as& $!a!

a!t&$*r$sa! atau a!a%$s( Namu!, r&so $.$# sam*&! m$!&!#at #$ta -$-$ra*a o-at

2a! &u!a#a!(


17/18

DAFTAR PUSTAKA

1( Mar+&a!o /, Po%%$t& P, Gu++$tta G, $t a%( T'$ &m*a0t o. $mora*'&0 0'a!$s o!

t'$ $*&$m&o%o2 o. '$r*$s +ost$r: S*a&! as a 0as$ stu2( T'$ Ro2a% So0&$t2

Pu-%&s'&!, Ita%2"71;:111"6(

"( C%&!&0a% K$2( H$r*$s Zost$r( A5a&%a-%$ at

'tt*s:??www(0%&!&0a%#$2(0om?to*&0s?$rmato%o2?'$r*$s+ost$r('tm%( No5 "71;(

6( Am$r&0a! Fam&%2 P'2s&0&a!( Ma!a$m$!t o. H$r*$s Zost$r 3S'&!%$s4 a!

Post'$r*$t&0 N$ura%&a( A5a&%a-%$ at

'tt*:??www(aa.*(or?a.*?"777?791;?*"96


18/18

9( Amao A, Soo A, Ta2%or S(Fitzpatricks Dermatology in General Medicine Ed .

T'$ M0GrawH&%% Com*a!&$s, U!&t$ Stat$s "77:

laporan kasus hz oticus

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