obat anti anemia

5/27/2018 Obat Anti Anemia

1/18

Antianemia agentsIron

Vit B12

Folic acid

Copper

Pyridoxine,riboflavine


2/18

Iron

Iron-porphyrin ring heme

Essential and non essential iron

Absorbed in duodenum,proxjejenum(ferrous iron)

Normal indiv:0,5-1mg daily

Absorption : vit c,HCl,co,inosin,etionin Absorption: phosphate,antacid, presence

of chelator or complexing agents


3/18

Transported in the plasma bound to

transferrin(specific for ferric iron)

developing erythroid cells in bone marrow Storage: ferritin , hemosiderinRE cells

Elimination: skin epithelial cells,exfoliation

of intestinal mucosal cells, bile, urine,nail,hair

Side effect(intolerance to oral prep):

nausea, epigastric discomf, abd cramps,

constipation, diarrhea


4/18

Indication : treatment/prevent of iron

deficiency anemia.

Definfants, rapid growth child,

pregnancy, lactating, post gastrectomy,

severe small bowel disease(malabsorpt),

blood loss(adult)

Treatment: - oral iron preparations

- parenteral iron preparations

Oral iron corrects the def just as rapidly

and completely as paranteral iron


5/18

Oral prep:- ferrous sulfate

- ferrous gluconate

- ferrous fumarate

200-400 mg daily for 3-6 months

Paranteral prep: Iron Dextran

50 mgelemental iron/ml solution

Note: Normal range of iron serum: 60-160mcgr/dl


6/18

Vit B12 and Folic acid

Vit B12+ folic acidintracellular metab

A def of either vit B12 or folic acid

defective synthesis of DNA in any cell

megaloblastic anemia

Vit B12cyanocobalamin and

hydroxocobalamin(therapeutic use)

Active forms in human: methylcobalamin

and deoxyadenosilcobalaminenzymatic

reactions


7/18

Absorption (oral) of B12intrinsic factor

of castle IFhistamine, cholinergic, corticosteroid,

ACTH, thyroid hormone

Def B12

neurological disorders FAcarrier of single carbon unitpurine,

pirimidine,amino acids interconversion

FA def: chronic alcoholism, oralcontraceptives, anti convulsants,

malnutrition, malabsorption, cytotoxic drug


8/18

R/ vit B12 def:

- initial dose: 100 mcgr IM/5-10 days,

then 100-200 mcgr IM/ month

R/ FA def:

- initial dose: 0,5-1mg/day

10 days,0,1-0,5mg/day

(inj 5mg/ml)

Note: Vit B12: 0,3-1ngr/ml, FA: 4-25ngr/ml


9/18

Erythropoietin

First human hematopoietic growth factor

Stimulates erythroid prolif and different

interacting w/ specific epo receptor Produced using recombinant DNA

technology

Ind: CRF w/ severe anemia Dose: 50-150 IU, 3x /week


10/18

Obat anti anemia

1. Besi2. Vitamin B12

3. Asam folat


11/18

Besi(Fe)

Esensial dan non esensial(cadangan)

Absorpsi bentuk fero

Absorpsi :Co, inosin, etionin,Hcl, dansenyawa asam

Absorpsi : fosfat, antasida


12/18

Cadangan: feritin(60%) dan

hemosiderin(40%)sel sel RE Ekskresidesquamasi sel-sel epitel,

kerigat, kuku, rambut,urin, feces

Efek samping intoleransi sediaan oral:- mual dan nyeri lambung

- konstipasi

- diare dan kolik intestinal


13/18

Sediaan dan posologi

OralFe-sulfat, Fe-fumarat,Fe glukonat)

ParenteralIron dextran(imferon)-----

50mg/ml

Dosis R/berat anemia


14/18

Vitamin B12

Cianokobalamin dan hidroksokobalamin

Bentuk aktif: metilkobalamin dan 5-deoksi

adenosilkobalamin

Fungsi :metabolisme intra sel

Absorpsi memerlukan FIC(Faktor Intrinsik

Castle) Defisiensigangguan metabolisme intra

sel asam folat & neurologic disorders


15/18

Dosis terapi tergantung berat anemia

Awal100 mic/hr selama 5-10 hr (IM)penunjang100-200 mic/bln sampai

remisi lengkap


16/18

Asam folat

Carrier single carbon unit Bentuk aktif: folinic acid

= asam tetrahidrofolat

Fungsi sbg carrier carbon utk sintesis purin-pirimidin dan interkonversi asam2 amino

Defisiensi folattransfer carbonunit

terganggu

sisntesis proteinterganggusintesis purin-pirimidinDNA

mitosis anemia megaloblastik


17/18

Defisiensi folattidak disertai ggn

neurologik Sediaan: tablet dan injeksi(sk,im)

Dosis R/awal 0,5-1mg/hr selama 10 hr

penunjang 0,1-0,5 mg/hr


18/18

Erythropoietin

First human hematopoietic growth factor

Stimulates erythroid prolif and different

interacting w/ specific epo receptor Produced using recombinant DNA

technology

Ind: CRF w/ severe anemia Dose: 50-150 IU, 3x a week

obat anti anemia

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