FARMAKOLOGI OBAT SISTEM RESPIRATORORIUS

Setyawati SKFarmakologi FKUB

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PENDAHULUAN

• Penyakit yang banyak terjadi pada sistem respiratorius berkaitan dengan pernafasan dan fungsi paru, misal :• Infeksi saluran nafas• Alergi• Inflamasi• Obstruksi jalan nafas (asma dan

penyakit paru obstruksi menahun/ PPOM lainnya)

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• Obat-obat yang bekerja pada sistem respiratorius • Antihistamin• Nasal dekongestan • Obat batuk & mukolitik• Bronkhodilator• Kortikosteroid• Kromoglikat• Antagonis Leukotrien

Saluran nafas atasSimptomatik

Saluran nafas bawah

ANTIHISTAMIN

• Digunakan untuk alergi nasal• Antihistamin generasi I sedasi

• Chlorpheniramin maleat (chlortrimeton=ctm)

• Diphenhydramin (delladryl, benadryl)• Prometazin (Phenergan)

• Antihistamin generasi II non sedasi• Loratadin• Terfenadin• Cetirizin

Efek Samping

Dekongestan

Simpatomimetik Agonis adrenergik Ephedrin, pseudoephedrin Phenylpropanolamin (PPA) Phenylephrin

vasokonstriksi

mukosa & sekresi berkurang

hidung longgar

Efek Samping ?

Topikal tetes, semprot

Dekongestan

• Nursing alerts:• Overuse of topical nasal decongestants can

cause rebound congestion, meaning that the congestion can be worse with the use of drug. To minimise this, drug therapy should be discontinued gradually.

• The use of topical agents is limited to no more than 3 to 5 days

• The patient’s blood pressure and pulse should be assessed before a decongestant is administered

• Inform the patient that nasal burning and stinging may occur with topical decongestants

ANTITUSIF

• Menekan reflex batuk di pusat batuk /SSP• Indikasi : batuk non produktif/ iritasi• Contoh obat : - narkotik kodein

- non narkotik noskapin

dekstrometorphan• Efek samping : - depresi

- konstipasi (narkotik)• Kontraindikasi : ?

• Nursing Alerts:• Observe for excessive suppression of the

cough reflex (inability to cough effectively when secretions are present). This is a potentially serious adverse effect because retained secretions may lead to lungs collapse, pneumonia, hypoxia, hypercarbia, and respiratory failure

EKSPEKTORAN

• Merangsang pengeluaran sekret/ mukus

batuk• Indikasi batuk produktif• Contoh obat : - Ipekak

- Amonium klorida (NH4Cl)

- Gliseril guaiakolat• Mukus kental, kuning mukolitik

antibiotik

Kontraindikasi ?

MUKOLITIK

• Mengencerkan sekret sal.nafas memecah mukoprotein & mukopoliskarida sputum

• Contoh obat : - bromheksin - ambroxol - asetilcystein

OBAT-OBAT ASMA BRONKHIALE

PATOFISIOLOGI ASMA BRONKHIALE

Penyakit inflamasi sal.nafas

(sel-sel inflamasi)

Gejala - hiperresponsif bronkhus thd stimuli penyempitan bronkhus

Gamb.patologi * bronkhokonstriksi * penebalan mukosa ok edema & infiltrasi sel * sekresi mukus >

Ag (polutan, alergen)

Ag-Ab/IgE di mast cell

MEDIATOR

Late response : Early response :Inflamation Bronchoconstriction

Hyperreactivity Symptom

Ag (polutan, alergen) hindari

Ag-Ab/IgE di mast cell kromolin, steroid

MEDIATORsteroid agonis , teofilin, anti kholinergikLate response : Early response :Inflamation Bronchoconstriction

Hyperreactivity Symptom

TERAPI

TERAPI1. BRONKHODILATOR

2. ANTIINFLAMASI

3. LAIN-LAIN * mukolitik* antitusif, ekspektoran ?

* antihistamin* antibiotik jk.perlu* preventif kromolin

steroidCATATAN :JIKA HIPOKSIA (pd status asmatikus) OKSIGEN

BRONKHODILATOR

1.SIMPATOMIMETIK/ ADRENERGIK- adrenalin/ epinefrin- efedrin- isoproterenol, isoprenalin- agonis 2 selektif

2. DERIVAT XANTIN - teofilin Phosphodiesterase inhibitor cAMP me ningkat relaksasi otot polos bronkus

3. ANTIKHOLINERGIK- atropin- ipatropium bromid

Agonis adrenergik 2 selektif

- Terbutalin (Allupent)- Albuterol (Salbutamol)- Metaproterenol efektif pd - Fenoterol serangan akut- FormoterolSelektivitas pada reseptor adr.2

Efektif pd pemberian -p.o. -aerosol onset

cepat

langs.reseptor

Efek samping

-aritmia ok stimulasi 1 jantung-tremor, musc.cramps-gangguan metabolisme-iritasi pada penggunaan inhaler-penggunaan lama reseptor

desensitif

tolerans

Nursing AlertsWhen 2 or more puffs are needed, inform the patient that at least 1 minute should be allowed between puffsInform the patient that salmeterol and formoterol, and oral β-2 agonists should be taken on a fixed schedule, not on a prn basisInstruct the patient to report chest pain and changes in heart rhythm or rate, because β-2 agonists can cause cardiac stimulationContact physician if symptoms such as nervousness, insomnia, restlessness and tremor become severe

DERIVAT XANTIN

METYLXANTIN TEOFILLIN

TEOBROMIN

CAFFEIN

EFEK - Relaksasi otot polos bronkhus- Stimulasi SSP- Stimulasi otot jantung- Diuresis- Asam lambung

FARMAKOKINETIK

- absorpsi baik : - p.o., “sustained release” kadar stabil di plasma

- p.e. iv- distribusi : slrh tubuh plasenta, ASI - metabolisme: hepar

ok -induksi enz o/ rifampin, fenobarbtal, etanol

-rokok ok -inhibisi enz o/ simetidin,

eritromisin, alopurinol -gagal jantung, liver dis.

-orang tua

EFEK SAMPING

-iv.cepat aritmia jantung, hipotensi

-Sakit kepala, palpitasi, dizziness, nausea,

hipotensi, nyeri prekordial

-Indeks terapi sempit

dosis besar takikardia,

agitasi kejang,

emesis, Gx.GIT

-Anak-2 mudah kejang

• Nursing alerts:

• Plasma theophylline levels should be monitored to keep it in the therapeutic range, usually 5-15 µg/ml. Dosage should be adjusted to keep theophylline levels below 20 µg/ml

• If patients miss a dose, the following dose should not be doubled

• Instruct the patient that sustained-release formulations should be swallowed intact

• Caution patients in consuming caffeine containing-beverages and other sources of caffeine. Caffeine can intensify the adverse effects and decrease the metabolism of theophylline

ANTIKHOLINERGIK*ATROPIN : iv; aerosol

*IPATROPIUM BROMID : aerosol

Mekanisme :-Antagonis res.kholinergik M

# otot polos bronkhodilatasi# kelenjar mukus

Efek sistemik :-Mulut kering, retensi urin, mata kabur, takikardiEfektif u/ hiperreaktif bronkhokonstriksi

PPOM, bronkhitis kronis, orang tua

ANTIINFLAMASI

KORTIKOSTEROID

EFEK :-langsung otot polos bronkus (-)-inflamasi -hiperreaktivitas-efek pd reseptor adr. : kepekaan

Obat : prednison, prednisolon p.o mild asma : inhaler

EFEK SAMPING

-lokal : kandidiasis, iritasi

-sistemik : supresi adrenal retensi Na dan air osteophorosis ulkus peptikum metab. KH “moon face”, “buffalo hump”

• Nursing alerts• Rinse mouth with water without swallowing

after administration to reduce the risk of candidiasis

• If taking bronchodilators by inhalation, use bronchodilators several minutes before the corticosteroid to enhance application of the corticosteroid into the bronchial tract

KROMOLIN

-per inhalasi

-stabilisasi mast cell degranulasi (-)

-efek samping :

. Batuk, edem laryng, nyeri sendi,

sakit kepala, rash, nausea

-indikasi :

- preventif serangan asma

Contoh ketotifen

• Nursing Alerts :• Cromoglycates are for long-term

prophylaxis, patients should administer on a regular schedule & the full therapeutic effects may take several weeks to develop

• They are contraindicated in patients who are hypersensitive to the drugs