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ASPEK FARMASETIKA IBU MENYUSUI

ASPEK FARMASETIKA IBU MENYUSUI. Iis Wahyuningsih. Ekskresi Obat dalam ASI. Obat dimakan ibu –diekskresikan dlm ASI, sebag. Dlm jumlah sedikit, sebag. Dlm jumlah cukup berpengaruh pd bayi Dipengaruhi : ♣ gradien pH antara plasma-ASI ♣ pKa obat ♣ koefisien partisi obat

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ASPEK FARMASETIKA IBU MENYUSUI

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  1. ASPEK FARMASETIKA IBU MENYUSUI Iis Wahyuningsih

  2. Ekskresi Obat dalam ASI • Obat dimakan ibu –diekskresikan dlm ASI, sebag. Dlm jumlah sedikit, sebag. Dlm jumlah cukup berpengaruh pd bayi • Dipengaruhi : ♣ gradien pH antara plasma-ASI ♣ pKa obat ♣ koefisien partisi obat ♣ distribusi obat dlm mekanisme transpor tubuh ♣ gradien konsentrasi obat antara plasma-ASI (pH darah 7,4 dan pH ASI 6,8)

  3. Sifat Fisiologis ASI • pH lebih rendah dr plasma • Kapasitas protein dlm serum lebih rendah • Kadar lemak lebih tinggi

  4. Konsentrasi Obat dlm ASI, dipengaruhi : • Dosis obat • Jalur pemberian • Porsi obat yang terikat protein plasma • BM obat • Kelarutan obat dlm lipid • Derajat ionisasi • Gradien pH • Penyakit ibu (gangguan hati & ginjal)

  5. pKa obat • Obat basa lebih banyak dlm ASI cth : eritromisin, INH, sotalol: rasio ASI/plasma > 1 • Obat asam : rasio ASI/plasma < 0,5 cth : penisillin, aspirin, sulfonamida, diuretika, diklofenak, AINS

  6. Ikatan Protein • Jumlah protein dlm ASI <<, obat dg ikatan protein tinggi tetap di dlm plasma, shg kadar dlm ASI << • Cth : warfarin (ikatan dg protein 95%)

  7. Lactation Risk Categories(AAP) • L1 (safest) • L2 (safer) • L3 (moderately safe) • L4 (possibly hazardous) • L5 (contraindicated)

  8. L1 • Amoxicillin, Magnesium sulfate, Loratadine • Cefadroxil, Triprolidine, B-12 (Cyanocobalamin) • Cefazolin • Cefoxitin • Cefprozil • Ceftazidime • Penicillin

  9. L2 • Ketorolac, Ceftriaxone, Gentamicin, Kanamycin • Piroxicam, Nitrofurantoin, Ofloxacin • Halothane, Sulfisoxazole, Warfarin • Lidocaine, Carbamazepine, Phenytoin, Valproic acid • Cimetidine, Fluconazole, Ketoconazole • Cisapride, Acyclovir, Interferon-alpha • Cefotaxime, Terbutaline, Loperamide

  10. L3 • Indomethacin, Streptomycin • Codeine, Trimethoprim/sulfamethoxazole • Methadone, Theophylline • Morphine, Contraceptive pill with estrogen/progesterone • Thiopental, Codeine, Pseudoephedrine • Ciprofloxacin, Tolbutamide • Clindamycin, Chlorothiazide, Diltiazem/Diltiazem HCL

  11. L4 • Cisplatin (Anti-cancer) • Dapsone (Antileprosy) • Nalidixic acid (Urinary Anti-infective) • Nadolol • Colchicine

  12. L5 • Gold salts • Bromide

  13. Alergi Obat • Bayi defisiensi G6PD • G6PD : enzim dlm sel darah merah, berfungsi mempertahankan senyawa glutation (antioksidan), bila kurang sel darah merah mengalami hemolisis (tek. Oksidatif naik) • Cth : aspirin, klorpromazin, nitrofurantoin, kina, kuinolon, sulfonamida

  14. Obat yg Mempengaruhi Produksi ASI • Menghambat : estrogen, tiazid, levodopa, siproheptadine, bromokriptin, nikotin, pyridoksin • Meningkatkan : metokloperamid, cimetidin, reserpin, metyldopa • Menghambat refleks penghisapan bayi : fenobarbital

  15. Obat & Resiko Bayi Diberi ASI

  16. lanjutan

  17. lanjutan

  18. terima kasih

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