INTERAKSI OBAT farmasi farmasi.jPPT.pptx

Interaksi obat

1. INTERAKSI OBAT VINI FATIKA DEWI

2. 1. Resep R/ Amlodipine 5mg no. V Bisoprolol 5mg no. V Atorvastatin 20mg no. V Lansoprazole no. X Valisanbe 5mg no. V

3. Nama Obat Komposisi Indikasi Aturan Pakai Dalam Resep Dosis Lazim ( Literatur ) Amlodipine Amlodipine Hipertensi , Angina 1 kali sehari 1 Tablet H: 5-10mg 1 kali sehari A: 5-10mg 1 kali sehari Bisoprolol Bisoprolol Fumarat Hipertensi 1 kali sehari 1 Tablet H: 2,5-10mg/ hari Atorvastatin Atorvastatin Ca Kolesterol , Hiperlipidemia 1 kali sehari pada malam hari 1 Tablet H: 10-20mg 1 kali sehari Lansoprazole Lansoprazole GERD, Esofagitis , Ulkus Duodenum 2 kali sehari sebelum makan 1 Tablet GERD: 15 mg sekali sehari (8 minggu) E: 30 mg sekali sehari (8 minggu) UD: 15 mg sekali sehari (4 minggu) Valisanbe Diazepam Anti Konvulsan , Status Epilepticus , Gelisah , Penenang 1 kali sehari pada malam hari 1 Tablet AK: 5mg/ dosis dapat diulang dalam 4-12 jam jika diperlukan SE: I.V .: 5-10 mg setiap 5-10 menit G: Oral: 5-10mg P: 20-60mg 2. Nama Obat , Komposisi , Indikasi , dan Dosis

4. 3. Bahas Interaksi Obat Berdasarkan Drugs.com Level Signifikan Moderate 3 kasus Amlodipine >< Bisoprolol Diazepam >< Bisoprolol Lansoprazole >< Atorvastatin

5. Obat yang Berinteraksi Mekanisme (drugs.com) Jenis Interaksi FK/FD Level Kemaknaan Tahap Rekomendasi Amlodipine >< Bisoprolol Kontraktilitas jantung terjadi bila penghambat saluran kalsium (amlodipine) dengan beta blocker Bisoprolol mengurangi kontraktilitas jantung sekunder akibat blokade beta Penurunan resistansi vaskular perifer sekunder akibat blokade saluran kalsium Perlambatan aditif dalam konduksi AV Farmakodinamik Moderat Monitoring tekanan darah . 2. Pemantauan klinis respons hemodinamik pasien .

6. Obat yang Berinteraksi Mekanisme (drugs.com) Jenis Interaksi FK/FD Level Kemaknaan Tahap Rekomendasi Diazepam >< Bisoprolol Banyak agen aktif dan psikoterapis menunjukkan efek hipotensi , terutama saat inisiasi terapi dan peningkatan dosis . Pemberian antihipertensi dan agen hipotensi lainnya , khususnya vasodilator dan penghambat alfa , dapat menyebabkan efek aditif pada tekanan darah dan orthostasis . Farmakodinamika Moderat Monitoring tekanan darah 2. Pasien disarankan menghindari naik tiba-tiba dari posisi duduk atau telentang dan memberi tahu dokter jika mengalami pusing , pusing , sinkop , ortostasis , atau takikardia .

7. Obat yang Berinteraksi Mekanisme (drugs.com) Jenis Interaksi FK/FD Level Kemaknaan Tahap Rekomendasi Lansoprazole >< Atorvastatin Pemberian bersama dengan esomeprazol dapat meningkatkan konsentrasi atorvastatin plasma dan risiko miopati Penghambatan kompetitif dari P- glikoprotein usus , yang mengakibatkan penurunan sekresi obat ke dalam lumen usus dan peningkatan ketersediaan hayati obat Farmakokinetika Moderat 1. Pasien yang diobati penghambat reduktase HMG-CoA disarankan melaporkan kepada dokter setiap rasa sakit , atau kelemahan otot yang tidak dapat dijelaskan , terutama jika disertai dengan malaise atau demam . Terapi harus dihentikan jika creatine kinase meningkat tajam / miopati didiagnosis .

8. Amlodipine >< Bisoprolol MONITOR: Additive reductions in heart rate, cardiac conduction, and cardiac contractility may occur when calcium channel blockers are used concomitantly with beta blockers, particularly in patients with ventricular or conduction abnormalities. While this combination may be useful and effective in some situations, potentially serious cardiovascular adverse effects such as congestive heart failure, severe hypotension, and/or exacerbation of angina may occur. The proposed mechanisms include additive slowing in AV conduction, reduced cardiac contractility secondary to beta-blockade, and decreased peripheral vascular resistance secondary to calcium channel blockade. In addition, some calcium channel blockers may inhibit the CYP450 metabolism of hepatically metabolized beta blockers, resulting in increased serum concentrations.  MANAGEMENT: Close clinical monitoring of patient hemodynamic response and tolerance is recommended if a calcium channel blocker is prescribed with a beta blocker, and the dosage of one or both agents adjusted as necessary. The same precaution should be observed when beta blocker ophthalmic solutions are used, since they are systemically absorbed and can produce clinically significant systemic effects even at low or undetectable plasma levels.

9. Diazepam >< Bisoprolol MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis . MANAGEMENT: Caution is advised during coadministration of these agents. Close monitoring for development of hypotension is recommended. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis , or tachycardia.

10. Lansoprazole >< Atorvastatin MONITOR: A case report suggests that coadministration with esomeprazole may increase the plasma concentrations of atorvastatin and the associated risk of myopathy. The proposed mechanism is competitive inhibition of intestinal P-glycoprotein, resulting in decreased drug secretion into the intestinal lumen and increased drug bioavailability. Another, perhaps minor mechanism is competitive inhibition of CYP450 3A4 metabolism. The interaction was suspected in a patient treated with atorvastatin (more than 1 year) and esomeprazole (6 weeks) who developed rhabdomyolysis with AV block two days after the addition of clarithromycin. The patient reported experiencing symptoms of increased fatigue, mild chest pain, and shortness of breath that coincided with the initiation of esomeprazole approximately six weeks prior to admission. Theoretically, the interaction may also occur with other proton pump inhibitors like lansoprazole , omeprazole, and pantoprazole and HMG-CoA reductase inhibitors like lovastatin and simvastatin, since these drugs are all substrates of P-glycoprotein and CYP450 3A4. MANAGEMENT : Because of the increased risk of musculoskeletal toxicity associated with high levels of HMG-CoA reductase inhibitory activity in plasma, patients treated with atorvastatin, lovastatin, simvastatin, and red yeast rice (which contains lovastatin) should be monitored more closely during concomitant use of proton pump inhibitors. All patients treated with HMG-CoA reductase inhibitors should be advised to promptly report to their physician any unexplained muscle pain, tenderness, or weakness, particularly if accompanied by malaise or fever. Therapy should be discontinued if creatine kinase is markedly elevated or if myopathy is suspected or diagnosed.