GENERAL banget PHARMACOLOGY S2 Indo.pptx

GENERAL banget PHARMACOLOGY S2 Indo.pptx

1. By R. Muchtan SUJATNO 25 Feb 2023 14.00 – 16.00 GENERAL PHARMACOLOGY 1

2. INTRODUCTION Farmakologi Klinik dan Terapi Ilmi Dasar: Pengantar terapi Farmakodinamik (FD) Farmakokinetik (FK) Absorpsi Obat dan Rute Pemberian Efek Penyakit pada disposisi obat ADR’s Dll / FARMAKOLOGI KLINIK DEALS WITH THE EFFECTS OF DRUGS IN HUMANS 2

3. 1 . PENGANTAR TERAPI/INTRODUCTION TO THRAPEUTICS Penggunaan Obat Efek merugikan (Adverse) dan risko /benefit Sejarah obat dan Rencana pengobatan , Formularium dan daftar terbatas /restricted lists Berdasarkan Scientific basis of use of drugs in humans. Penggunaan Obat /Use of drugs - Bergantung pada D/, pengobatan terdiri dari kepastian (reassurance), bedah , atau intervensi lain. - Obat2an sering untuk terapi primer atau sebagai tambahan lain. - Dr dari semua spesialis menggunakan obat secara extensive dan membutuhkan untuk mengerti pada basis ilmiah . - WHO menganjurkan 12 kunci intervensi memajukan lbh rasional pada penggunaan obat . 3

4. Continue…….https://www.who.int ( diunduh 11Mei 2021) 1. Pembentukan Badan multidisiplin National mengkoordinasi kebijakan pnggunaan obat . 2. Gunakan panduan klink . 3. Pengembangan dan penggunaan national essential medicines list 4. Pembentukan Komite Obat dan Terapi di distrik dan hospital 5. Termasuk masalah pelatihan farmakoterapi dasar pada kurikulum under graduate curricula 6. Pendidikan pelayanan medis berklanjutan as a licensure requirement . 7. Supervisi audit dan feedback 8. Gunakan informasi independen on medicines 9. Pedidikan pada masyarakat masalah obat . 10. Hindari insentif finansial yang buruk . 11. Gunakan regulasi yg sesuai dan dipaksakan . 12. Pengeluaran pemerintah yg memadai utk memastikan ketersediaan obat dan staf 4

5. 2. ADR’s Semua obat yg efektif mempunyai adverse effects Keputusan pengobatan sebagai dasar adalah risk/benefit Bagaimana cara penulisan resep yg eror diminimaliser ? Dengan kombinasi pengetahuan umum dari pathogenesis of the disease, how??? Duke and Swartz : Tanggungjawab terhadap drug induced injury ….. Ada 8 kewajiban untuk pembuat resep : Penggunaan terbats /Restrictive use---- apakah drug therapy terjamin ? Pilih hati2 obat yg sesuai dan dose regiment Konsultasi dan dan consent Peresepan dan recording Explanation Supervisi (including monitoring) Terminasi sbg penyesuaian 8. Kesusuaian dg hukum yg berkaitan dg peresepan . 5

6. ADVERSE EFFECT AND RISK/BENEFIT continued……. Hipppocratic principle: First Do No Harm Because the opportunities for doing good were so limited e g: cures of leukemias , Hodgkin’s disease and testicular Ca…..to accept a degree of containable harm Alergic reactions : 6

7. MINIMAL , BERIKUT INI DASAR SEBAGAI PERTIMBANGAN BILA MEMUTUSKAN therapeutic plan : Umur Coexisting disease especially renal and or hepatic impairment Kemungkinan kehamilan Riwayat obat (Drug history) Terbaik adalah berharap secara wajar utk individual pasien . Kepercayaan pasien dan tepat sasaran . 3. RIWAYAT OBAT (Drug History) dan RANCANGAN TERAPI (THERAPEUTIC PLAN) Pada abad 21: Dapat diandalkan drug history melibatkan pertanyaan pada pasien (kdg2 famili , tetangga , dokter lain nya , dsb ). Peresepan apa yg akan diambil : tablet, medicines, drops, contraceptive, creams, supp, or pessaries,etc 7

8. What over-the-counter remedies are being used including herbal medicine or “alternative therapies “? Does the patient use drugs socially or for “life-style” purposes? Have they suffered drug-induced allergies or other serious reactions? Have they been treated for anything similar in the past, and if so..in what and did it do. Apakah mempunyai beberapa reaksi obat yg serius diantara anggota keluarga ?. Excessive itchy skin that peels off after taking medication to watch out for Steven Johnson Syndrom Kulit Gatal Berlebihan Hingga Mengelupas Setelah Minum Obat ? Waspada Gejala Stevens-Johnson Syndrome Penulis resep harus keduanya : muticulous and humble Resep harus ditulis jelas dan terang menyesuaikan dg legal requirements 8

9. 4. Formularium and Restricted Lists Daftar formularium sutau komponen campuran ditulis sampai kira2 thn 1950. The perceived need for hospital formularies disappeared transiently when such mixtures were replaced by proprietary products prepared by pharmaceutical industry. Many hospital and Primary Health Care trusts have reintroduced formularies that are essentially restricted lists of the drugs stocked by institution’s of pharmacy. Such formularies have the advantage of encouraging consistency and once a decision has been made with input from local consultant prescribers they are usually well accepted. 9

10. 5. Scientific Basis of Use of Drugs in Humans The scientific of drug action is provided by the discipline of pharmacology. Clinical Pharmacology deals with the effects of drugs in humans It entails the study of : interaction of drug with their receptors or non receptors the transduction (second messenger) systems to which these are link and the changes that they bring about in cells, organs, and the whole organism These processes are called pharmacodynamics ( What the drug does to the body) The use of drug in society is encompassed by Pharmacoepidemiology and Pharmacoeconomics Man is mammal and animal studies are essential Modern method of molecular and cell biology…….. Hopefully improving the relevance of preclinical pharmacology and toxicology. 10

11. New Drug Development In the past drug were found by trial and error Now they are developed primarily by systematic scientific research. FDA carefully monitors new drug development , which can take many years to complete. Only after reviewing extensive animal study (preclinical study) and data on the safety and effectiveness of the proposed drug will the FDA approve… BPOM Phases of New Drug Development Phase I : The drug is tested on healthy volunteers Phase II : Involve trials with people who have the disease for which the drug is thought to be effective Phase III : Large numbers of patients in medical research centers . This larger sampling provides information about infrequent or rare adverse effect. Phase IV : is voluntary and involves post marketing surveillance of the drug’s therapeutic 11

12. POWER PLANT The active components consist of several types and vary in character and effect Alkaloids, the most active component in plants , react with acids to form a salt that can dissolve more readily in body fluids. Glycosides , are also active components round in plants. Name of glycosides usually end –in such as dogoxin Gums constitute another group of active components . Gums give products the ability to attract and hold water. Examples include seaweed extractions and seeds with starch Resins of which the chief source is pine tree sap, commonly act as local irritants or as laxatives Oils, thick and sometimes greasy liquid, are classified as volatile or fixed. Examples of volatile oils, which readily evaporate, include peppermint, spearmint and juniper. Fixed oils which aren’t easily evaporated, include castor oil and olive oil. 12

13. . 2. Pharmacodynamics : The biochemical and physical effects of drugs and the mechanism of action 3. Pharmacokinetics : The ADME of a drug 4. Drug Absorption and routes of administration A Drug ‘s administration route influence s the quantity given and the rate at which the drug is absorbed and distributed. (In Pharmacokinetics) 4.1 ABSORPTION Abs is the transfer of a drug from its site of adm to the blood stream The rate and efficiency of abs depend on the route of adm . For IV abs is complete. Drug adm by other routes may result in only partial abs. 13

14. Absorption……. Transport of Drug from the GI tract The rate and efficiency of abs depend on the route of adm , for IV abs is complete . A. Transport of drug from GT tract (Oral) Drug may be absorbed from the GI tract by either passive diffusion or active transport Passive diffusion The driving force for passive abs of a drug is the concentration gradient across a membrane separating two body compartments that is the drug moves from a region of high conc to a region a low conc. Active transport This mode of drug entry involves specific carrier protein and show saturation kinetics Active transport is energy dependent and is driven by the hydrolysis of ATP It is capable of moving drugs against a conc. Gradient, that is from a low region of low drug conc to a region of high drug conc B. Effect of pH on drug absorption Many drugs are either weak acids or weak bases Acidic drugs (HA) release aH + causing a charged anion A- to form HA <-> H+ + A- Weak bases BH+ can also release aH + , however the protonated form of basic drugs is usually charge, and loss of a proton produces the unchanged base (B) HB+ <-> B + H+ See below….. 14

15. Fig 1.DRUG ABSORPTIO BY DIFFUSION Fig 2. EFFECT OF pH ON DRUG ABSORPTION 15

16. Transport of drug ……… A drug tends to pass through membranes if it is uncharged , thus for a weak acid, the unchanged HA can permeate through membranes, and A- can’t. For a weak base the uncharged B penetrates through the cell membrane, and BH+ does not. C. Physical factors 1. Blood flow to the absorption site, blood flow to the intestine is much greater than the flow to the stomach 2. Total surface area available for absorption. Intestine has a surface rich in microvilli it has a far greater surface area than that of the stomach 3. Contact time at the absorption surface If a drug moves through the GI tract very quickly, it is not well absorbed ( diarrhea). Food both dilutes and slow gastric emptying. 4.2 Routes of Administration 4.2.1 Enteral a. Oral Giving a drug by mouth. 16

17. b. Par enteral The main three major parenteral routes are : IV, IM, and subcutaneous c. Other : Inhalation, Topical and Transdermal , Rectal ( Suppositoria ) , Vaginam ( Ovula ).. Fig 3. Schematic representation Fig 4.Commonly used routes of drugs Fig 5. First-pass- metab can of drug ADME adm (IV; IM;S.C) occur with orally adm (I V) 17

18. KEY POINTS Drugs are prescribed by physicians of all specialties This carries risk as well as benefits Therapy is optimized by combining general knowledge of drugs with knowledge of an individual patient Evidence of efficacy is based on clinical trials, but the drug side effect profile becomes clearer only when widely prescribed. Rational prescribing is encouraged by local formularies 18

19. Literatures James M Ritter, Lionel D Lewis, Timothy GK Mant and Albert Ferro (2008). General Principles. Clinical Pharmacology and Therapeutics. Hodder Arnold Part of Hachette Livre UK., 5 th Ed. Richard A. Harvey , Pamela C. Champe , Mary J. Mycek , Sheldon B. Gertner and Maria Menna Perper (1992). Absorption, Distribution, and Elimination of Drugs in Lippincott’s Illustrated Reviews. p1-4. JB Lippincott Company. Judith A. Schiling McCann , RN, MSN (2009). Fundamental of Clinical Pharmacology in Clinical Pharmacology Made Incredibly Easy! 3 rd eds. in Lippincott William & Wilkins Philadelphia 3 rd Eds , p 57- 81 19