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TOKSIKOLOGI OBAT

TOKSIKOLOGI OBAT. OBAT YG SERING MENYEBABKAN KERACUNAN. ANTIHISTAMIN ANALGETIKA VITAMIN, MINERAL OBAT FLU HORMON ANTIBIOTIK INTERNAL. INDEKS TERAPI = LD 50 / ED 50 MAKIN BESAR MAKIN AMAN. URUTAN TOKSISITAS DITINJAU DARI RUTE PEMBERIAN:

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TOKSIKOLOGI OBAT

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  1. TOKSIKOLOGI OBAT

  2. OBAT YG SERING MENYEBABKAN KERACUNAN • ANTIHISTAMIN • ANALGETIKA • VITAMIN, MINERAL • OBAT FLU • HORMON • ANTIBIOTIK INTERNAL

  3. INDEKS TERAPI = LD 50 / ED 50MAKIN BESAR MAKIN AMAN URUTAN TOKSISITAS DITINJAU DARI RUTE PEMBERIAN: IV > INHALASI > IP > SC > IM > INTRA DERMAL > ORAL > TOPIKAL

  4. PENANGANAN KERACUNAN PENILAIAN • FUNGSI RESPIRASI • FUNGSI KARDIOVASKULAR • GEJALA SSP • GEJALA LAIN • PENENTUAN KERACUANAN

  5. FAKTOR YGMEMPENGARUHITOKSISITAS • KOMPOSISI • DOSIS • RUTE PEMBERIAN • METABOLISME TOKSIK • KONDISI KESEHATAN • USIA KEMATANGAN • KONDISI NUTRISI • GENETIK • KELAMIN • LINGKUNGAN

  6. FAKTOR YANG MENENTUKAN TOKSISITAS • LD 50 • EFEK SAMPING • KECEPATAN TIMBULNYA EFEK

  7. CARA PENANGANAN • PENCUCIAN/LAVAGE • EMESIS • ADSORBENT • KATARTIK • DEMULSEN • DEKONTAMINASI TOPIKAL • MENINGKATKAN ELIMINASI ZAT TOKSIK • ANTIDOT

  8. PENCUCIAN JK RACUN HRS SGR DIKELUATKAN DR LAMBUNG INDIKASI • 10TIDAK SADAR/SETENGAH SADAR • REFLEKS MENELAN HILANG: S.IPECAC TIDAK BISA • SANGAT TOKSIK & BANYAK

  9. KI :ZAT KOROSIF PASIEN KEJANG CAIRAN PENCUCIAN • NaHCO3 • Larutan Garam Ca • Larutan As.Tanat • KMNO4 • NaCl Fisiologis • Air

  10. EMESIS JK RACUN MASIH DI SAL CERNA • SIRUP IPECAC • APOMORFIN ALTERNATIF LAIN • LARUTAN SABUN • RANGSANGAN MEKANIK KI: OBAT KONVULSAN TDK SADAR/REFLEKS MENELAN – PENYAKIT CARDIOVASKULAR EMPISEMA

  11. ADSORBENJK RACUN DPT DIABS D/ ABSORBEN • KARBON AKTIF • KAOLIN • PEKTIN • ATALPUGIT • KOLESTIRAMIN ABSORBSI < :TOLBUTAMID, ZAT TDK LRT AIR

  12. KATARTIKJK DIDUGA ZAT TOKSIK SDH MSK USUS • MgSO4 • Mg SITRAT • Na SULFAT • Na FOSFAT • SORBITOL  Sbg pencahar

  13. DEMULSEN ES KRIM SUSU PUTIH TELUR  Lapisi muk zat racun yg korosif DEKONTAMINASI TOPIKAL AIR SABUN  u/ zat iritan

  14. PENINGKATAN ELIMINASI • DIURETIK KUAT • Yg dpt dikeluarkan diuretik kuat amfetamin,penicillin,salisilat,sulfonamida KI : ACETAMINOPHEN,FENOTIAZIN A.DEPRESSAN TRISIKLIK,barbiturat krj pendek *DIALISIS *PENGASAMAN/PEMBASAAN URIN

  15. ANTIDOT • KIMIA • RESEPTOR • DISPOSIONAL • FUNGSIONAL/FISIOLOGIS

  16. ANTIDOT ATROPIN---------------- DIAZEPAM-------------- DEKTROSE------------- ADRENALIN------------ DOPAMIN--------------- NALOKSON------------- NITROPRUSID---------- PROTAMIN SULFAT-- VIT K-----------------ASETIL SISTEIN----- RACUN/GEJALA KOLINESTERASE INH STIMULAN SSP HIPOGLIKEMIK ANAPHYLAKSIIS HIPOTENSI OPIOID HIPERTENSI HEPARIN ANTIKOAGULANORAL ACHETAMINOPHEN

  17. KERACUNAN ACETAMINOPHEN • MK: METABOLIT REAKTIF IK SEL NECROSIS HB MET HB(TDK IK O2) O2 PAR HB (ENZ MET HB REDUKTASE) KOFAKTOR : GLUTATION

  18. Anj  nekrosis hepatik • Kuc Met Hemoglobinemia DOSIS TOKSIK ANJ : 150 MG/KG KUC : 50 MG/KG (DOSIS AN: 80 MG REG: 325-500MG)

  19. GEJALA • ANJ: - DEPRESI - MUNTAH - SKT ABD - URIN,SERUM: GELAP - MATI ( 2-5 HR) • KUC - ANOREKSI,SALIVASI,VOMIT - DEPRESI - METHBNEMIA, HEMOGLOBINURIA - MEMBRAN CYANOTIK - URIN, DARAH GELAP - WAJAH EDEMA - MATI 18-36 J

  20. PROGNOSIS: JELEK • TREATMENT - <4J: EMESIS, GASTRIC LAVAGE, ACTIVATED CHARCOAL KUC: YOHIMBIN ANJ: APOMORPHIN -GROUP SULFHYDRYL:N- ACETILCYSTEINE 140 MG/KG - VIT C - SUPPORTIVE THERAPY -INFUSE : DECTROSE 2,5% -OXYGEN: -TRANSFUSI DRH

  21. ASPIRIN TOXICOSIS • KUC > SERING DRPD ANJ C/ KUC:DEF/AKT GLUCORONYL TRANSFERASE < (GT : DETOX & EKS ASPIRIN) EFEK TOKSIK: - TEKAN SUTUL - HAMB AGREGASI TROMBOSIT - METABOLIC ACIDOSIS - RENAL DISEASE - GASTRIC ULCERASI

  22. DOSIS TOXIC: - ANJ : 30 MG /KG/HR - KUC : 25 MG/KG/HR (ANAK : 81 MG REG : 325- 500 MG) GJL:-AKUT: DEPRESI, ANOREKSI, HIPERPIREXIA, VOMIT, ATAKSIA, COMA, MATI

  23. KRONIK: GASTRIK ULCER, PERFORASI, HEPATOTIKSIK, SUPRESI SUTUL TREATMENT 1. 6-12 J : EMETIK,GASTREK LAVAGE, ACT CHARCOAL, SALINE CATARTIK 2. DIURESIS : DIURETIK KUAT

  24. IBUPROFEN • NSAID YG TDK DIREKOMENDASI UTK PETS  IT SEMPIT • TOKSISITAS: - 150 mg/kg vomit, gastric ulcer - 300 mg/kg  ggl ginjal • PROG : JLK • TREAT: 1. EMETIK, GASTRIK L, A CHARCOAL 2. support: infus, diuresis 3. simpt: sucralfat, ranitidin, misotrostol g.ulcer

  25. ANTICOAGULANT • MK : -INH ENZ PD SINTESIS VIT K - INH FACT COAG PROD VIT K • TOXIC DOSE * ANJ : 5-300 MG/KG (1-5 MG/KG/HR 5-15 HR) * KUC: 5-30 MG/KG (1 MG/KG/HR 5 HR) • GJL:- DEPRESI,LEMAH - HEMATEMESIS,HEMATURIA,HEMORRHAGE - MATI HEMORRHAGE D/PLEURAL CAVITY • DX:-HISTORY - SCREENING KOAG: BLEEDING TIME, COAG TIME - ANALISIS A.COAG KIMIA

  26. TREATMENT 1. INDUKSI EMESIS, GASTRIC LAVAGE, ACTIVED CHATCOAL, CATHARTIC 2. ANTIDOTE: VIT K 3. TREAT CLINICAL SIGN - INTRAPULMONARY HEMORRHAGE: TRANSFUSI PLASMA, O2, TDK BOLEH DIBERI FUROSEMIDE INH FS PLATELET - HIPOVOLEMIC SHOCK: INFUSE,TRANSF DRH, KORTICOSTEROID,

  27. A.HISTAMIN&DECONGESTAN • DX: SEJARAH PSEUDOEPHEDRIN,(PHENYLPROPANOLAMINE)/PPA,DIPHENHYDRAMINE, CHLORPHENIRAMINE • GJL:- DEPRESI, GG RESP, - HIPEREXCITABILITY - TREMOR, SEIZURES, HIPERACTIVITY - VOMIT, MIDRIASIS, HIPERTERMIA - DISORIENTASI - BRADICARD/TACHICARD

  28. PROG: BAIK • TREAT: 1. < 1 J INTAKEEMESIS 2. ACTIVATED CHARCOAL 3. SUPPORTIVE: INFUSE, O2 4. OBAT SEDATIVE HIPERACVTIVE (DIAZEPAM,PHENOBARBITAL) 5. PROPANOLOLTACHYCARDI 6. ATROPINE BRADYCARD

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