Laporan Farmako Dr.vivi-hipertensi

1

Praktikum Farmakologi A. Kasu Kasuss Hiper Hiperte tens nsii

 Nama

: Ny. S

 No. RM

: 001.664

TTL

: 15 Maret 1947

Jenis Kelamin

: Perempan

MRS

: !"# $ 15 %e&rari '016 p(l: ').)0

Kel*an

: Ny N yeri l  l *a *ati se se+a( 1 *ari ya yan, SM S MRS- M Mal /  /2$2K 2$2K &ai(- Sesa( Sesa( na3as - emam - psin, psin, saat  &er+alan /

RP#

: T /- #M - Jantn, /- stro(e 

#

: o&s. 8pi,astri pain- Ssp. 2#

#ata Klini( Pasien: K< T# R RR

15$' M 149$101 100 '0

16$' M 150$100 ;4 '0

17$'

1;$'

19$'

170$100 ;; '4

160$90 ;4 '0

160$90 ;4 '1

#ata La& Pasien:  Nilai Normal

16/2

&

1'-0

16-0 1'-6 ,$l

t Le(osit

,r$l )74) = 4.000

)7-6= 10.940 sel$mm)

trom&osit
10.000$mm) '00400r&$mel '040 m, 0-51-5m,$l '-46 m,$l 70'00

'97.000 sel$mm) )) m,$l 0-; m,$l 7-6 m,$l '17 m,$L

17/2

18/2

2

S">T S"PT Kolesterol Total Tri,liseria #L L#L K$N2 Troponin KM L# "#P "#'PP

?)7 $l ?47 $l ?'00 m,$l 50150 m,$l 4060 ?1)0 ?167

1; <$L 15 <$L 199 m,$L 1'7 m,$L 6'.4 m,$L 111 m,$L ;0 <$L Ne,ati3  

?'4 '404;0 70110 110140

15 <$L '7; <$L 15) m,$L '04 ,$L

Terapi Terapi yan, i apat(an:  Nama >&at eoar P"

#osis

2tran

5m, 75m,

Pa(ai )1$' ta& 001

15$'

16$'

17$'

1;$'

19$'

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Dasar Te Teori ori

1

HIPETE!"I Pato#isiologi Hipertensi

ipertensi apat ie3inisi(an se&a,ai te(anan ara* persisten imana imana te(anan sistoli(ny sistoli(nyaa i atas 140 mm, an iastoli( iastoli( i atas 90 mm,. Paa poplasi lansia- *ipertensi ie3inisi(an se&a,ai te(anan sistoli( 160 mm, an te(anan iastoli( 90 mm,. SmeltAer-'001 Menrt B> te(anan ara* sama en,an ata iatas 160 $ 95 mm, inyata(an se&a,ai *ipertensi. Klasi#ikasi

ipertensi paa sia lan+t i&ea(an atas : #armo+o- 1999 ipertensi imana te(anan sistoli( sama ata le&i* &esar ari 140 mm, an $ ata te(anan iastoli( sama ata le&i* &esar ari 90 mm,. ipertensi sistoli( terisolasi imana te(anan sistoli( le&i* &esar 

2

S">T S"PT Kolesterol Total Tri,liseria #L L#L K$N2 Troponin KM L# "#P "#'PP

?)7 $l ?47 $l ?'00 m,$l 50150 m,$l 4060 ?1)0 ?167

1; <$L 15 <$L 199 m,$L 1'7 m,$L 6'.4 m,$L 111 m,$L ;0 <$L Ne,ati3  

?'4 '404;0 70110 110140

15 <$L '7; <$L 15) m,$L '04 ,$L

Terapi Terapi yan, i apat(an:  Nama >&at eoar P"

#osis

2tran

5m, 75m,

Pa(ai )1$' ta& 001

15$'

16$'

17$'

1;$'

19$'

@ @

@ @

@ @

@

Dasar Te Teori ori

1

HIPETE!"I Pato#isiologi Hipertensi

ipertensi apat ie3inisi(an se&a,ai te(anan ara* persisten imana imana te(anan sistoli(ny sistoli(nyaa i atas 140 mm, an iastoli( iastoli( i atas 90 mm,. Paa poplasi lansia- *ipertensi ie3inisi(an se&a,ai te(anan sistoli( 160 mm, an te(anan iastoli( 90 mm,. SmeltAer-'001 Menrt B> te(anan ara* sama en,an ata iatas 160 $ 95 mm, inyata(an se&a,ai *ipertensi. Klasi#ikasi

ipertensi paa sia lan+t i&ea(an atas : #armo+o- 1999 ipertensi imana te(anan sistoli( sama ata le&i* &esar ari 140 mm, an $ ata te(anan iastoli( sama ata le&i* &esar ari 90 mm,. ipertensi sistoli( terisolasi imana te(anan sistoli( le&i* &esar 

3

ari 160 mm, an te(anan iastoli( le&i* rena* ari 90 mm,. Klasi3 Klasi3i(a i(asi si *iperte *ipertensi nsi &eras &erasar( ar(an an penye& penye&a&n a&nya ya apat apat i&ea i&ea(an (an men+ai ' ,olon,an &esar yait : 1$

ipertensi essensial  *ipertensi primer  yait *ipertensi yan, tia( i(eta*i penye&a&nya

2$

ipe iperte rtens nsii se( se(n ner er yait yait *ipe *ipert rten ensi si yan, yan, i se&a se&a&( &(an an ole* ole*  penya(it lain

Etiologi

Peny Penye& e&a& a& *ipe *iperte rtens nsii paa paa oran oran,, en, en,an an lan+ lan+tt sia sia aala aala** ter+ainya per&a*an per&a*an paa : 1$

8lastisitas inin, aorta menrn

2$

Katp +antn, mene&al an men+ai (a(

%$

Kemampan +antn, memompa ara* menrn 1= setiap ta*n sesa* &ermr '0 ta*n (emampan +antn, memompa ara* menrn menye&a&(an menrnnya (ontra(si an Colmenya.

&$

Ke*i Ke*ila lan, n,an an elas elasti tissitas itas pem& em&l l** ara* ara*.. al ini ini ter+ ter+a aii (are (arena( na(r ran an,n ,nya ya e3e(t e3e(ti3 i3ita itass pem& pem&l l* * ara* ara* peri3 peri3er er nt nt(  (  o(si,enasi Menin,(atnya resistensi pem&l* ara* peri3er  Mes( Mes(ip ipn n *ipe *iperte rtens nsii prim primer er &el &elm m i(e i(eta ta* *ii en, en,an an past pastii

 penye&a&nya- ataata penelitian tela* menem(an &e&erapa 3a(tor  yan, serin, menye&a&(an ter+ainya *ipertensi. %a(tor terse&t aala* se&a,ai &eri(t : 1$

%a(tor (etrnan #ari #ari ata ata stati statist sti( i( ter& ter&( (ti ti &a*D &a*Daa sese seseor oran an,, a(an a(an memi memili( li(ii (emn, (emn,(in (inan an le&i* le&i* &esar &esar nt( nt( menap menapat( at(an an *iperte *ipertensi nsi +i(a +i(a oran, tanya aala* penerita *ipertensi

4

2$

iri perseoran,an iri iri perseo perseoran ran,an ,an yan, yan, mempen mempen,ar ,ar*i *i tim&l tim&lnya nya *iperte *ipertensi nsi aala*: a$


'$

Jenis (elamin la(ila(i le&i* tin,,i ari perempan 

($

Ke&iasaan *ip

)$

Ke&ias Ke&iasaan aan *ip *ip yan, yan, serin, serin, menye&a menye&a&(a &(ann tim&l tim&lny nyaa *ipertensi aala* se&a,ai &eri(t : Konsmsi ,aram yan, tin,,i  mele&i*i ari )0 ,r  Ke,em(an ata ma(an &erle&i*an Stress Mero(o(  Minm al(o*ol Minm o&ato&atan ep*erine- prenison- epineprin Sean,(an penye&a& *ipertensi se(ner aala* : a$

"in+al :

"lomerlone3ritis-

Piel Pielon one3 e3rit ritis is-- Ne(r Ne(ros osis is t& t&la larr a(t a(t an an Tmor.  & Easlar Easlar

:

2teros(lerosis-

iperplasia- Trom&osis- 2nerisma- 8m&oli (olestrol- an Eas(litis.  8no(rin

:

#M-

ipotiroiisme  Sara Sara33 : Stro Stro(e (e-- 8n 8nse sepa pali liti ti..

ipertiroiisme-

5

e$

>&at : Kontrasepsi oral- Korti(osteroi

Pato#isiologi

Me(anisme yan, men,ontrol (onstri(si an rela(sasi pem&l* ara* terleta( ipsat Casomotor- paa mella iota(. #ari psat Casomotor ini &ermla +aras sara3 simpatis- yan, &erlan+t (e &aDa* (e (ora spinalis an (elar ari (olmna mella spinalis ,an,lia simpatis i tora(s an a&omen. Ran,san,an psat Casomotor  i*antar(an alam &ent( impls yan, &er,era( (e &aDa* melali system sara3 simpatis (e ,an,lia simpatis. Paa titi( ini- neron  pre,an,lion melepas(an asetil(olin- yan, a(an meran,san, sera&t sara3 pasa ,an,lion (e pem&l* ara*- imana en,an ilepas(annya noreepineprin men,a(i&at(an (onstri(si pem&l* ara*. er&a,ai 3a(tor seperti (eemasan an (eta(tan apat mempen,ar*i respon  pem&l* ara* ter*aap ran,san, Caso(onstri(si. !niCi en,an *ipertensi san,at sensitiC ter*aap norepine3rin- mes(ipn tia(  i(eta*i en,an +elas men,apa *al terse&t &isa ter+ai. Paa saat &ersamaan imana sistem sara3 simpatis meran,san,  pem&l* ara* se&a,ai respons ran,san, emosi- (elen+ar arenal +,a teran,san,- men,a(i&at(an tam&a*an a(tiCitas Caso(onstri(si. Mella arenal mense(resi epine3rin- yan, menye&a&(an Caso(onstri(si. Korte(s arenal mense(resi (ortisol an steroi lainnya- yan, apat memper(at respons Caso(onstri(tor pem&l* ara*. Easo(onstri(si yan, men,a(i&at(an penrnan aliran (e ,in+al- menye&a&(an  pelepasan rennin. Renin meran,san, pem&ent(an an,iotensin ! yan, (emian i&a* men+ai an,iotensin !!- sat Caso(onstri(tor (atyan, paa ,ilirannya meran,san, se(resi alosteron ole* (orte(s arenal. ormon ini menye&a&(an retensi natrim an air ole* t&ls ,in+al- menye&a&(an penin,(atan Colme intra Cas(ler. Sema 3a(tor  ini enern, menets(an (eaaan *ipertensi.

6

Se&a,ai pertim&an,an ,erontolo,is imana ter+ai per&a*an strtral

an

3n,sional

paa

system

pem&l*

peri3er 

 &ertan,,n,+aDa& paa per&a*an te(anan ara* yan, ter+ai paa sia lan+t. Per&a*an terse&t melipti ateros(lerosis- *ilan,nya elastisitas  +arin,an i(at an penrnan alam rela(sasi otot polos pem&l* ara*yan, paa ,ilirannya menrn(an (emampan istensi an aya re,an,  pem&l* ara*. Konse(ensinya- aorta an arteri &esar &er(ran, (emampannya alam men,a(omoasi Colme ara* yan, ipompa ole* +antn, Colme se(np men,a(i&at(an penrnan ran,  +antn, an penin,(atan ta*anan peri3er SmeltAer- '001. Paa sia lan+t perl iper*ati(an (emn,(inan aanya F*ipertensi palsG ise&a&(an (e(a(an arteri &ra*ialis se*in,,a tia( i(ompresi ole* 33 sp*y,momanometer #armo+o- '009.

Tana an ,e+ala paa *ipertensi i&ea(an men+ai : a Tia( aa ,e+ala. Tia( aa ,e+ala yan, spesi3i( yan, apat i*&n,(an en,an penin,(atan te(anan ara*- selain penentan te(anan arteri ole* o(ter yan, memeri(sa. al ini &erarti *ipertensi arterial tia( a(an perna* teria,nosa +i(a te(anan arteri tia( ter(r.  & "e+ala yan, laAim Serin, i(ata(an &a*Da ,e+ala terlaAim yan, menyertai *ipertensi melipti nyeri (epala an (elela*an. #alam (enyataannya ini merpa(an ,e+ala terlaAim yan, men,enai (e&anya(an pasien yan, menari pertolon,an meis. Menrt Ro(*aeni '001- mani3estasi (linis &e&erapa pasien yan, menerita *ipertensi yait : Men,el* sa(it (epala- psin, Lemas(elela*an- Sesa( na3as- "elisa*- Mal Mnta*- 8pista(sis- Kesaaran menrn. 2$ DI"PEP"IA

7

Ulkus Peptikum a$ De#inisi

Seara patolo,i anatomis- t(a( lam&n, ulkus peptikum aala* (ersa(an ata *ilan,nya +arin,an m(osa- s&m(osa- sampai lapisan otot aera* salran penernaan ma(anan yan, &ermani(an airan lam&n, asampepsin- en,an &atas ta+am an &ersi3at +ina(. T(a( lam&n, &anya(  terapat i aera* anthrum- an palin, serin, i curvatura minor lam&n, ;;=- sean,(an 5= item(an sepan+an, rCatra mayor "anon,- '010. '$ Etiologi

anya( (e+aian t(a( pepti( menn+((an aanya asam an pepsin (eti(a H. Pylori,  NS2!#- ata 3a(tor lain men,,an,, perta*anan m(osa an me(anisme penyem&*an. iperse(resi asam aala* me(anisme  pato,eni( yan, tama paa tin,(at hypersecretory seperti Zollinger-Ellison  syndrome H8S "anon,- '010.

($ Patogenesis


8

tertent seperti aspirin- al(o*ol- inometasin- 3enil &taAon an (orti(osteroi mempnyai e3e( lan,sn, ter*aap m(osa lam&n, an menim&l(an t(a(. >&at lain- seperti (a3ein a(an menin,(at(an pem&ent(an asam. Stres emosi apat +,a meme,an, peranan alam pato,enesis t(a( pepti(- en,an menin,(at(an pem&ent(an asam se&a,ai a(i&at peran,san,an Ca,s "yton an all- '01'. %a(tor *ereiter- paa t(a( pepti( le&i* serin, ter+ai ') (ali ari (elar,anya yan, menapat t(a( pepti( i&anin, ari poplasi normal. Paa ,olon,an ara* > iapat(an )4= le&i* serin, ari ,olon,an ara* lainnya an t(a( pepti(nya le&i* serin, i oenm "yton an all'01'. %n,si Sp*inter pilors yan, a&normal men,a(i&at(an re3l(s empe an ian,,ap merpa(an me(anisme pato,eneti( tim&lnya t(a(  lam&n,. 8mpe men,,an,, saDar m(osa lam&n,- menye&a&(an ,astritis an penin,(atan (epe(aan ter*aap pem&ent(an t(a( Bilson an Linset*- '005. Selain it- aanya in3e(si . pylori apat men,*anr(an saDar  m(osa ,astrooenale se*in,,a ter+ai i3si &ali( asampepsin leDat m(osa yan, terl(a an &er(em&an, men+ai l(s "yton an all'01'. 

Heli(o'a(ter p*lori

a(teri . pylori aala* &a(teri yan, san,at s(a paa (onisi (elem&apan yan, tin,,i- memerl(an (ar&onio(sia yan, lmayan &anya( &t* sei(it o(si,en- an &ersi3at san,at pato,eni(. a(teri ini +,a mempnyai (en,,lan ya(ni &erta*an an &er(em&an, &ia( alam lam&n,. Seara mm- aa ) me(anisme in3e(si &a(teri . pylori yan, menye&a&(an t(a( lam&n,. Pertama- . pylori men,in3e(si &a,ian &aDa* lam&n, antrm. Kea- setela* in3e(si a(an ter+ai peraan,an &a(teri yan, men,a(i&at(an  peraan,an lenir lam&n, ,astritis- peristiDa ini serin,(ali ter+ai tanpa  penampa(an ,e+ala asimptomoti(. Keti,a- ter+ainya peraan,an apat

9

 &erimpli(asi ter+ainya t(a( lam&n, ata ss 1' +ari. al ini &isa ter+ai (ompli(asi a(t- yait l(a en,an penara*an an l(a &erl&an, "yton an all- '01'. e$ +or#ologi

Sema l(s pepti(m &ai( lam&n, mapn oenm- memili(i si3at asar yan, sama nt( ,am&aran ma(ros(opisnya. er&ent( &lat tapi &atas ta+am men,enai m(osa sampai s&m(osa- &iasanya sampai ms(laris. Kaan, mala* menem&s inin, otot. Kaan,(aan, pem&l* ara* yan, ter,ers apat tampa( paa asar imana merpa(an penye&a& (ematian (arena perara*an "yton an all- '01'. "am&aran *istolo,isnya &erCariasi ter,antn, a(tiCitas- (ronisitas- an era+at penyem&*annya. Paa 3ase a(ti3 apat item(an paa asar an tepi l(s terapat lapisan tipis &a*an ne(roti( 3i&rinoi- yan, i &aDa*nya tampa( aera* a(ti3 en,an peraan,an spesi3i( en,an selsel PMN yan, ominan. #i &aDa*nya la,i terapat +arin,an ,ranlasi a(ti3. a,ian teralam- le&i* paat 3i&rosis en,an +arin,an part (ola,en yan, i&atasi  perm(aan serosa. #inin, pem&l* ara* alam aera* +arin,an part mene&al- an (aan,(aan, terapat trom&ose tetapi paa &e&erapa (eaaan tetap paten an mele&ar. Paa lesi i lam&n, paa aera* tepi- menn+((an ,am&aran sat ,astritis (roni( atro3i an serin,(ali terapat metaplasi ari (elen+ar ,aster paa aera* ,astritis "yton an all- '01'. #$ ,am'aran klinis

Tim&lnya rasa nyeri ata peri* &ilamana lam&n, alam (eaaan (oson,- tim&l (el*an pert rasa pen* an &ertam&a* &erat setela* ma(an. isanya rasa mal &ertam&a* &erat an ii(ti en,an mnta*mnta*. Ian, imnta*(an aala* yan, ima(an tai- ii(ti en,an sisasisa ma(anan yan, &erDarna *itam. Seran,an nyeri *e&at mn,(in tim&l en,an perioe  peristalti( lam&n,. ilamana penerita tia( se,era minta tolon,- ma(a lam&n, ma(in mem&esar- lama (elamaan nyeripn &er(ran,- tetapi rasa  pen* i pert tetap aa yan, isertai en,an rasa mal- an mnta*mnta*

10

 pn &er(ran,. erat &aan penerita menrn- emi(ian pla &ertam&a* lema*- yan, +,a tim&l (onstipasi "yton an all- '01'. "e+ala (lasi( ari t(a( pepti( aala* nyeri. Paa t(a( lam&n,- rasa sa(it tim&l )090 menit sesa* ma(an- an paa t(a( oenm- ') +am sesa* ma(an. Ma(anan (eil yan, tia( men,iritasi an yan, ters meners ima(an alam selan, Da(t yan, pene( apat men,ran,i nyeri. #en,an pen,o&atan &iasanya rasa sa(it men,*ilan, alam 10 *ari- tetapi  proses penyem&*an &erlan,sn, 1' &lan "yton an all- '01'. Seara mm pasien t(a( ,aster men,el* ispepsia. #ispepsia aala* sat sinrom ata (mplan (el*an &e&erapa penya(it salran erna seperti- mal- mnta*- (em&n,- nyeri l *ati- senaDa ata terapan- rasa ter&a(ar- rasa pen* l *ati- an epat merasa (enyan, "yton an all'01'. g$ Diagnosis

2namnesis &er*ar,a alam menri,ai l(s lam&n,- tetapi tia( (*as seperti paa l(s oeni. #a metoe tama nt( ia,nosis aala*  pemeri(saan &arim an enos(opi. Pemeri(saan &arim en,an men,,na(an &arim sl3at alam airan ata sspensi yan, itelan. Me(anisme menelan apat seara lan,sn, ili*at en,an 3loros(opi- ata ,am&aran sinar apat ire(am en,an men,,na(an te(ni( pen,am&ilan ,am&ar &er,era( sinemato,ra3i. "am&aran enos(opi apat &erpa eritematos ata e(sati3- erosi3lat- erosi raise- atro3i- *emora,i(- re3l(s ata *iperplasi r,ae. T(a( lam&n, &iasanya i(enali en,an pemeri(saan  &arim en,an (etepatan (ira(ira ;0=. T(a( lam&n, yan, &er*&n,an en,an NS2!# serin, (ali le&i* sper3iial an (ran, serin, i(enali seara raio,ra3i(. ai( t(a( lam&n, yan, +ina( mapn yan, ,anas le&i* serin,  paa (rCatra minor ari paa (rCatra mayor. Raiasi lipatan m(osa lam&n, ari pin,,iran (aDa* t(a( mem&eri (esan le&i* +ina(. T(a(  lam&n, yan, &esar- yait yan, &eriameter le&i* &esar ari ) m le&i* serin, ,anas ari paa yan, le&i* (eil. T(a( alam sat massa seperti itent(an seara raio,eni( +,a mem&eri (esan (e,anasan. Kira(ira 4=

11

t(a( lam&n, yan, tampa(nya +ina( seara raiolo,i( ter&(ti ,anas en,an &iopsi enos(opi( ata paa operasi "yton an all- '01'.
Panreas yan, ise&t (elen+ar la* pert- aala* (elen+ar pen,*asil inslin yan, terleta( i &ela(an, lam&n,. #i alamnya terapat (mplan sel yan, &er&ent( seperti pla paa peta- (arena it ise&t plapla Lan,er*ans yan, &erisi sel &eta yan, men,elar(an *ormone inslin yan, san,t &erperan alam men,atr (aar ,l(osa ara*. !nslin yan, i(elar(an ole* sel &eta tai apat ii&arat(an se&a,ai ana( (ni yan, apat mem&(a pint mas(nya ,l(osa (e alam sel- nt(  (emian i alam sel ,l(osa terse&t imeta&olisasi(an men+ai tena,a. ila islin tia( aa- ma(a ,l(osa alam ara* tia( apat mas( (e alam sel en,an a(i&at (aar ,l(osa alam ara* tia( apat mas( (e alams el en,an a(i&at (aar ,l(osa alam ara* menin,(at. Keaaan inila* yan, ter+ai paa ia&etes mellits tipe 1. Paa (eaaan ia&etes mellits tipe '- +mla* inslin &isa normal &a*(an le&i* &anya(- tetapi +mla* reseptor penan,(ap inslin i  perm(aan sel (ran,. Reseptor inslin ini apat ii&arat(an se&a,ai l&an, (ni pint mas( (e alam sel. Paa (eaaan #M tipe '- +mla* l&an,

12

(ninya (ran,- se*in,,a mes(ipn ana( (ninya inslin &anya(- tetapi (arena l&an, (ninya reseptor (ran,- ma(a ,l(osa yan, mas( (e alam sel sei(it- se*in,,a sel (e(ran,an &a*an &a(ar ,l(osa an (aar  ,l(osa alam ara* menin,(at. #en,an emi(ian (eaaan ini sama en,an (eaaan #M tipe 1- &anya aala* paa #M tipe ' isampin, (aar ,l(osa tin,,i- (aar inslin +,a tin,,i ata normal. Paa #M tipe ' +,a &isa item(an +mla* inslin (p ata le&i* tetapi (alitasnya (ran, &ai(se*in,,a ,a,al mem&aDa ,l(osa mas( (e alam sel. #i sampin, penye&a& i atas- #M +,a &isa ter+ai a(i&at ,an,,an transport ,l(osa i alam sel se*in,,a ,a,al i,na(an se&a,ai &a*an &a(ar nt( meta&olism ener,i. '$ Faktor Pen(etus

%a(tor &i&it merpa(an penye&a& tama tim&lnya penya(it ia&etes i sampin, penye&a& lain seperti in3e(si- (e*amilan- an o&ato&atan. Tetapimes(ipn emi(ian- paa oran, en,an &i&it ia&etes- &elmla* men+amin tim&lnya penya(it ia&etes. Masi* mn,(in &i&it ini tia( menampa((an iri seara nyata sampai a(*ir *ayatnya. e&erapa 3a(tor yan, apat meny&r(an an serin, merpa(an 3a(tor   pernets ia&etes mellits aala* : a  &   e

(ran, ,era($ malas ma(anan &erle&i*an (e*amilan (e(ran,an pro(si *ormone inslin penya(it *ormone yan, (er+anya &erlaDanan en,an inslin.

,ui)eline T-erap*

"ieline T*erapy
13

"am&ar 1.' "ieline T*erapy nt( ispepsia "aeline Terapi
14

"am&ar 1.) "aeline nt(
"aeline Terapi ipertensi

15

"am&ar 1.4 "ieline t*erapy 3or ipertensi

Farmakologi

16

1. AEI Kaptopril a$ Farmakokinetika A : >ral D : Plasma + : ati E : "in+al (eali %osinopril '$ Farmako)inamika

Men,*am&at enAim yi. peptiil ipeptiase yan, men,*irolisis an,iotensin ! men+ai an,iotensin !! an men,ina(ti3(an &rai(inin- sat Casoilator poten yan, &e(er+a palin, tia( en,an meran,san, pen,elaran nitrat o(sia an  prostasi(lin. e3e( lain yait e3e( in*i&isi sistem renin an,iotensin an e3e(  stimlator sistem (ali(rein(inin. aa +,a e3e( se&a,ai anta,onis reseptor   &rai(inin an menrn(an te(anan ara*. !n*i&itor an,iotensin !! menrn(an te(anan ara* tertama melali  penrnan resistensi Cas(lar peri3er. ($ In)ikasi

Pasien *ipertensi en,an ,a,al ,in+al (roni( an ia&etes. )$ Kontra in)ikasi

Banita *amil trimester ' (arena &eresi(o *ipotensi- anria- ,a,al ,in+al  +anin isertai mal3ormasi ata (ematian +anin. Kaptopril alam osis &esar  menin,(at(an resi(o pasien en,an ins3iensi ,in+al. e$ E#ek samping

iper(alemia- *ipotensi &erat- &at( (erin,- men,i- an,ioeema. #$

Interakasi 'at

Splemen (alim ata ireti( *emat (alim- NS2#. at g$ An0uran Pa)a Kasus

17

#en,an pasien *ipertensi an resi(o ia&etes- apat i&eri(an o&at +enis 28! (arena o&at o&at ini apat memper&ai(i *emoinami(a intrarenal penrnan resistensi arteriol e3eren ,lomerls- an &er(ran,nya te(anan intra(apiler ,lomerls. Menye&a&(an e3e( men,ran,i proteinria an mensta&il(an 3n,si ,in+al paa penerita ia&etes en,an ins3iensi ,in+al.

2. PE!,HA+AT P+PA PT! PPI$ mepra3ole

Pen,*am&at pompa proton merpa(an pen,*am&at se(resi asam iam&n, le&i* (at ari 2'. >&at ini &e(er+a i proses tera(*ir pro(si asam lam&n,- le&i* istal ari 2MP. Saat ma yan, i,na(an i (lini( aaia* omepraAol- esomepraAoi- lansopraAol- ra&epraAol an pantopraAoi. Per&eaan antara (elima seiaan terse&t aala* paa s&stitsi i inin piriin an$ata  &enAimiaAol. >mepraAol aala* ampran rasemi( isomer R an S. 8somepraAol aaia* isomer S omepraAoi SomepraAol yan, men,alami eliminasi le&i* larn&at ari RomepraAol. a$ Farmako)inamik 

Pen,*am&at pompa proton sat pror, yan, mem&t*(an

sasanaasam nt( a(tiCasinya. Setela* la&sorpsi n mas( (e air(lasl sistaml( o&at in a(an &eri3si (e sel parietal !am&n,- ter(rnpl l (anali(ii sa(retoar an men,alami a(tiCasi isit men+ai &ent(  sl3onami te3rasi(li(. ent( a(Ai3 ini &eri(atan en,an ,,s si3*iril enAim - K- 2TPase enAim ini i(ena se&a,ai pompa proton an  &eraa i mem&ran apl(al set parietal. !(atan ini menye&a&(an ter+ainya  pen,*am&atan enAim terse&t. Pro(si asam lam&n, ter*enti ;0$0 s$0 95=- setela* pen,*am&atan pompa proton terse&t. Pen,*am&atan  &erlan,sn, lama antara '44; +am an apat menrn(an sa(resi asam lam&n, &asal ata a(i&at stimlasi lepas ari +enis peran,san,nya *istamin- asetil(olin ata ,astrin. am&atan ini si3atnya ireCersi&el pro(si asam &ar apat (em&ali ter+ai setela* )4 *ari pen,o&atan i*enti(an.

18

'$ Farmakokinetik 

Pen,*am&at pompa proton se&ai(nya i&eri(an aiam seiaan salt enteri( nt( mene,a* e,raasi Aat a(ti3 terse&t alamsasana asam. Seiaan

ini

tia(

men,alami

a(tiCasi

i

lam&n,

se*in,,a

 &ioaCaila&ilitasnya le&i*&ai(. Ta&let yan, pea* i lam&n, men,alami a(tiCasi lal teri(at paa &er&a,ai ,,s si3*iril m(s an ma(anan. ioaCaila&ilitasnya a(an menrn sampai en,an 50= (arena pen,ar* ma(anan. >le* se&a& it se&ai(nya i&eri(an )0 menit se&elm ma(an. >&at ini mempnyai masala* &ioaCaila&ilitas- 3ormlasi &er&ea memperii*at(an presentasi +mla* a&sorpsi yan, &erCariasi las. ioaCaita&ilitas ta&let yan, &(an salt enteri( menin,(at alam 57 *ariini apat i+elas(an en,an &er(ran,nya pro(si asam lam&n, setela* o&at &e(er+a- >&at ini imeta&olisme i *ati ole* sito(rom P450 IP tertama IP'19 an IP)24. ($ In)ikasi

!ni(asi pen,*am&at pompa proton sama en,an 2' yait paa  penya(it pepti(. Ter*aap sinrom Hollin,er8llison- o&at ini apat mene(an pro(si asam lam&n, le&i* &ai( ari 2' )$ E#ek "amping

83e( sampin, yan, mm ter+ai mal- nyeri pert- (onstipasimyopati s&a(t- ram (lit. Keaaan *iper,astrinemia le&i* serin, teOal an !e&i* &erat paa pen,,naan PPi i&ann,(an en,an ' anta,onis. Se&esar 510= Pasien yan, men,,na(an PP! seara (roni( leCel ,astrinnya menin,(at sampai  500 m,$L. Keaaan *iper,astrinemia ini apat rnenye&a&(an re&on *iperse(resi asam lam&n, paa pen,*entian terapi PP! yan, a(i&atnya apat men,in(si tmor ,astrointestinal.

e$ Interaksi o'at

19

PP! apat mempen,ar*i eliminasi &e&erapa o&at yan, mempnyai  +alr meta&olisme yan, sama en,annya antara lain Dar3arin esomepraAol- lansopraAo( omepraAol an ta&epraAol- iaAepam esomepraAol- omepraAol an si(losporin omepraAol an ra&epraAol. #i antara P!! *anya omepraAol yan, apat men,*am&at a(ti3itas enAim IP'19 3enitoin an &e&erapa o&at iain imata&olisme ole* enAim terse&t serta men,in(si IP12' se*in,,ia menin,(at(an (lirens imipramin- &e&erapa o&at antipsi(oti(- ta(rin 1)11 3eoQlin.

Penatalaksanaan Kasus )an Pem'a-asan Dengan +eto)e "AP 1. "u'0ekti# 

 Nama

: Ny. S

 No. RM

: 001.664

TTL

: 15 Maret 1947

Jenis Kelamin

: Perempan

MRS

: !"# $ 15 %e&rari '016 p(l: ').)0

Kel*an

: Nyeri l *ati se+a( 1 *ari yan, SMRS- Mal /2$2K &ai(- Sesa( na3as  psin, saat &er+alan /

RP#

: T /- #M - Jantn, /- stro(e 

#

: o&s. 8pi,astri pain- Ssp. 2#

2. '0ekti# 

emam -

20

#ata Klini( Pasien: K< T# R RR

15$' M 149$101 100 '0

16$' M 150$100 ;4 '0

17$'

1;$'

19$'

170$100 ;; '4

160$90 ;4 '0

160$90 ;4 '1

#ata La& Pasien:  Nilai Normal

16/2

&

1'16 ,$l

1'-6 ,$l

t

)74)=

)7-6=

Le(osit

400010000

10.940

sel$mm)

sel$mm)

'00000400000

'97.000

sel$mm)

sel$mm)


'040 m,$l

)) m,$l

Kreatinin

1-) m,$l

0-; m,$l

2sam
'-47 m,$l

7-6 m,$l

"#S

140 m,$l

'17 m,$L

S">T

?); <$L

1; <$L

S"PT

?41 <$L

15 <$L

Trom&osit

Kolesterol Total '00 m,$L

199 m,$L

Tri,liseria

'00 m,$L

1'7 m,$L

#L

65 m,$L

6'.4 m,$L

L#L

?1)0 m,$L

111 m,$L

K$N2

?167 <$L

;0 <$L

Troponin

?0-1 m,$L

Ne,ati3  

17/2

18/2

21

KM

?'5<$L

15 <$L

L#

'404;0 <$L

'7; <$L

"#P

70110 m,$L

15) m,$L

"#'PP

110140 m,$L

'04 ,$L

Terapi yan, i apat(an:  Nama >&at

#osis

2tran

15$'

16$'

17$'

1;$'

19$'

@

@

@

@

@

@

@

@

@

@

Pa(ai Kaptopril

'5  100 Se&elm m,$*ari

>mepraAole

4



ma(an '0 Se&elm

m,$*ari

ma(an

Assesment )an Plan Tgl

"u'0e(t

15$'

Nyeri

'0e(t

l

*ati- T# 149$101

Assesment

Plan

ipertensi ,rae 1

Kaptopril



ipertensi ,rae 1

Kaptopril



#M

Tia( iterapi

#ispepsia

>mepraAole

 111

mal- an psin, 16$'

saat &er+alan Nyeri l *ati- T# 150$100 mal- an psin, "#S '17 saat &er+alan

 111

 001



22

17$'

Nyeri

l

*ati- T# 170$100

ipertensi ,rae '

Kaptopril

#ispepsia

>mepraAole



saat &er+alan Nyeri l *ati- T# 160$90

ipertensi ,rae '

Kaptopril

 111

mal- an psin, "#P 15)

#M

Tia( iterapi

ipertensi ,rae '

Kaptopril

#ispepsia

>mepraAole

mal- an psin, 1;$'

Nyeri

l

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

"#'PP '04

saat &er+alan 19$'

 111



*ati- T# 160$90

 111



mal- an psin, saat &er+alan

 001



P4A!

Terapi 3arma(olo,i R$ Kaptopril 50 m, No.!!! S. )  ta& 1 *.m R$>mepraAol 40m, No.!!! S. 1  ta& 1 *.m

Terapi !on Farmakologi !on Farmakologi untuk "uspe(t AD

2. Re*a&ilitasi mei( a,i penerita yan, sean, men,alami seran,an +antn, tina(an yan, ila((an meman, &ersi3at arrat an i(er+a(an en,an epat. Seperti mela((an ran,san,an men,,na(an listri( &erte,an,an tin,,i (eti(a +antn,  &er*enti &erenyt. Paa (onisi penan,anan +antn, seperti ini- tina(an yan, epat merpa(an prioritas tama. Pasien yan, men,alami seran,an  +antn, an pasa operasi paa mmnya men,alami ,an,,an paa 3n,si

23

3n,si or,an t&*nya. Karena it nt( menin,(at(an (emampan or,an it  palin, tia( mene(ati (onisi semla ila((an re*a&ilitasi mei( en,an ma(s nt( men,optimal(an 3isi(- 3isiolo,i an sosial paa pasienpasien yan, se&elmnya menerita (e+aian (arioCas(lar. #i Rma* Sa(it Jantn, an Pem&l* #ara* arapan Kita ila(sana(an re*a&ilitasi meis en,an (onsep terpa. Jenis pelayanan re*a&ilitasi mena(p: 1. Tes eCalasi- en,an treamill ata 8sroyle test '. Pela(sanaan 3isioterapi ). Pela(sanaan monitorin, telemetri 4. Pro,ram Re*a&ilitasi %ase !! an !!! 5. Re*a&ilitasi Pasa M! ata Pasa >perasi i ran, raDat 6. Treamill analyser$8r,oyle analyAer 7. olter ;. Lea Potensial 9. Ee(tor T+an : 1.
24

mela((an a(tiCitas sean, selama )060 menit )4$min,, +alan &ersepea- &erenan, ata a(tiCitas aero&i yan, sesai 4. #iet men,(onsmsi ma(anan en,an (aar (olesterol rena* ata lema( en,an satrasi rena* 5. Kolesterol men,(onsmsi o&ato&atan penrn (olesterol. Tar,et primer (olesterol L#L ? 100m,$l. 6. ipertensi tar,et te(anan ara* ?1)0$;0 mm,.

!on Farmakologi untuk tukak peptik 

1. !stira*at Seara mm pasien t(a( ian+r(an pen,o&atan raDat +alan- &ila (ran,  &er*asil ata aa (ompli(asi &ar ian+r(an raDat inap. Penyem&*an a(an le&i* epat en,an raDat inap Dalapn me(anismenya &elm +elas- (emn,(inan ole*&ertam&a*nya +mla* istira*at- &er(ran,nya re3l(s empe- stress- an  pen,,naan anal,eti(. Stress an (eemasan meme,an, peran alam penin,(atan asam lam&n, an penya(it t(a(. '. #iet Ma(anan lna( apala,i &&r sarin,- ma(anan yan, men,ann, ss tia( le&i* &ai( ari paa ma(anan &iasa- (arena ma(anan *als a(an meran,san,  pen,elaran asam. a&ai- ma(anan yan, meran,san,- ma(anan men,ann, asam apat menim&l(an rasa sa(it paa &e&erapa pasien- Dalapn &elm iapat &(ti (eter(aitannya. e&erapa peneliti men,an+r(an ma(anan &iasa lna(- tia( meran,san, an iet seim&an,. Mero(o( men,*alan,i penyem&*an t(a( ,aster (roni(- men,*am&at se(resi &i(ar&onat pan(reas- menam&a* (easaman &l&s oeni- menam&a* re3l(s oeno,astri( a(i&at rela(sasi s3in,ter pilors se(ali,s menin,(at(an (e(am&*an t(a(. !on #armakologi untuk Hipertensi 1$

Men+alani pola *ip se*at tela* &anya( ter&(ti apat menrn(an te(anan ara*- an seara mm san,at

25

men,ntn,(an alam menrn(an risi(o permasala*an (arioCas(lar. 2$

Penrnan &erat &aan.

%$

Men,ran,i aspan ,aram.

&$

>la*ra,a yan, ila((an seara teratr se&anya( )0 60 menit$ *ari- minimal ) *ari$ min,,- apat menolon, penrnan te(anan ara*.

5$

Men,ran,i (onsmsi al(o*ol.

!on #armakologi Dia'etes +elitus tipe II D+$ 1$

Men+a,a te(anan ara* (ran, ari 1)0$;0 mm,

2$

Pro3il lipi L#L?100 m,$l-#L  40 m,$l an tri,liseri ? '00 m,$l

%$

Men+a,a &erat &aan a,ar tiap ieal

&$

Mela((an lati*an 3isi( selama )0 menit$lati*an se&anya( )4 selama semin,,

Kesimpulan

ipertensi apat ie3inisi(an se&a,ai te(anan ara* persisten imana te(anan sistoli(nya i atas 140 mm, an iastoli( i atas 90 mm,. Paa  poplasi lansia- *ipertensi ie3inisi(an se&a,ai te(anan sistoli( 160 mm, an te(anan iastoli( 90 mm,. SmeltAer-'001 Menrt B> te(anan ara* sama en,an ata iatas 160 $ 95 mm, inyata(an se&a,ai *ipertensi. Penye&a& *ipertensi paa oran, en,an lan+t sia aala* ter+ainya per&a*an per&a*an  paa : elastisitas inin, aorta menrn- (atp +antn, mene&al an men+ai (a(- (emampan +antn, memompa ara* menrn 1= setiap ta*n sesa*  &ermr '0 ta*n (emampan +antn, memompa ara* menrn menye&a&(an

26

menrnnya (ontra(si an Colmenya- (e*ilan,an elastisitas pem&l* ara*. al ini ter+ai (arena(ran,nya e3e(ti3itas pem&l* ara* peri3er nt( o(si,enasi Menin,(atnya resistensi pem&l* ara* peri3er. Terapi non 3arma(olo,i yan, &iasanya ila((an en,an ara : Men+alani  pola *ip se*at tela* &anya( ter&(ti apat menrn(an te(anan ara*- an seara mm san,at men,ntn,(an alam menrn(an risi(o permasala*an (arioCas(lar- penrnan &erat &aan- men,ran,i aspan ,aram- ola*ra,a yan, ila((an seara teratr se&anya( )0 60 menit$ *ari- minimal ) *ari$ min,,apat menolon, penrnan te(anan ara*- an men,ran,i (onsmsi al(o*ol. e&erapa 3a(tor yan, apat meny&r(an an serin, merpa(an 3a(tor   pernets ia&etes mellits aala* : (ran, ,era($ malas ma(anan &erle&i*an (e*amilan (e(ran,an pro(si *ormone inslin- penya(it *ormone yan, (er+anya &erlaDanan en,an inslin. Terapi 3arma(oli,i yan, serin, ila((an en,an men+a,a te(anan ara* (ran, ari 1)0$;0 mm,- pro3il lipi L#L?100 m,$l-#L  40 m,$l an tri,liseri ? '00 m,$l- men+a,a &erat &aan a,ar tiap ieal- mela((an lati*an 3isi( selama )0 menit$lati*an se&anya( )4 selama semin,,. T(a( lam&n,  ulkus peptikum aala* (ersa(an ata *ilan,nya +arin,an m(osa- s&m(osa- sampai lapisan otot aera* salran penernaan ma(anan yan, &ermani(an airan lam&n, asampepsin- en,an &atas ta+am an &ersi3at  +ina(. T(a( lam&n, &anya( terapat i aera* anthrum- an palin, serin, i curvatura minor

lam&n, ;;=- sean,(an 5= item(an sepan+an, rCatra

mayor. anya( (e+aian t(a( pepti( menn+((an aanya asam an pepsin (eti(a  H. Pylori,

 NS2!#- ata 3a(tor lain men,,an,, perta*anan m(osa an

me(anisme penyem&*an. iperse(resi asam aala* me(anisme pato,eni( yan, tama paa tin,(at hypersecretory seperti Zollinger-Ellison syndrome H8S. Terapi non 3arma(olo,i yan, &iasanya ila((an yait en,an ara : 1. !stira*at- seara mm pasien t(a( ian+r(an pen,o&atan raDat +alan- &ila (ran, &er*asil ata aa (ompli(asi &ar ian+r(an raDat inap. Penyem&*an

27

a(an le&i* epat en,an raDat inap Dalapn me(anismenya &elm +elas(emn,(inan ole*&ertam&a*nya +mla* istira*at- &er(ran,nya re3l(s empestress- an pen,,naan anal,eti(. Stress an (eemasan meme,an, peran alam  penin,(atan asam lam&n, an penya(it t(a(. '. #iet- ma(anan lna( apala,i  &&r sarin,- ma(anan yan, men,ann, ss tia( le&i* &ai( ari paa ma(anan  &iasa- (arena ma(anan *als a(an meran,san, pen,elaran asam. a&ai- ma(anan yan, meran,san,- ma(anan men,ann, asam apat menim&l(an rasa sa(it  paa &e&erapa pasien- Dalapn &elm iapat &(ti (eter(aitannya. e&erapa  peneliti men,an+r(an ma(anan &iasa lna(- tia( meran,san, an iet seim&an,. ). Mero(o(- men,*alan,i penyem&*an t(a( ,aster (roni(- men,*am&at se(resi &i(ar&onat pan(reas- menam&a* (easaman &l&s oeni- menam&a* re3l(s oeno,astri( a(i&at rela(sasi s3in,ter pilors se(ali,s menin,(at(an (e(am&*an t(a(.

28

K2S
 Nama

: Tn M

 No. RM

: '70919;9

TTL

: '0 Maret 1970

Jenis Kelamin

: La(i  la(i

MRS

: !"# $ 1; %e&rari '016 p(l: ').00

Kel*an

: sesa( na3as an &at( /- emam / semalamT - #M  - Jantn,  - Stro(e - 2sma /

#

: T

#ata Klini( Pasien: K< T# R RR S*

Tampa( lemas an pat 1)0$;0 mm, 100 $ menit '; $ menit )6-7o 

#ata La&oratorim Pasien  Nilai Normal & 1)-)  16-' L8# 0  15 Le(osit 5.000  11.000 sel$mm ) Pemeri(saan T2 Ne,atiCe

1;$' 1'-7 1 +am '0 menit 10.710 sel$mm) Positi3  

Dasar Teori

1$ T Pato#isiologi T

Par merpa(an port entrUe le&i* ari 9;= (ass in3e(si T. Karena (rannya yan, san,at (eil- (man T alam peri( reni(  droplet nuclei

29

yan, ter*irp- apat menapai alCeols. Mas(nya (man T ini a(an se,era iatasi ole* me(anisme imnolo,is non spesi3i(. Ma(ro3a, alCeols a(an men3a,osit (man T an &iasanya san,,p men,*anr(an se&a,ian &esar  (man T. 2(an tetapi- paa se&a,ian (eil (ass- ma(ro3a, tia( mamp men,*anr(an (man T an (man a(an &erepli(asi alam ma(ro3a,. Kman T alam ma(ro3a, yan, ters &er(em&an, &ia(- a(*irnya a(an mem&ent( (oloni i tempat terse&t. Lo(asi pertama (oloni (man T i  +arin,an par ise&t %o(s Primer ">N. #ari 3os primer- (man T menye&ar melali salran lim3e men+ (elen+ar lim3e re,ional- yait (elen+ar lim3e yan, mempnyai salran lim3e (e lo(asi 3os primer. Penye&aran ini menye&a&(an ter+ainya in3lamasi i salran lim3e lim3an,itis an i (elen+ar lim3e lim3aenitis yan, ter(ena. Ji(a 3os primer terleta( i lo&s par &aDa* ata ten,a*- (elen+ar lim3e yan, a(an terli&at aala* (elen+ar lim3e para*ils- sean,(an +i(a 3os  primer terleta( i ape(s par- yan, a(an terli&at aala* (elen+ar paratra(eal. Komple(s primer merpa(an ,a&n,an antara 3os primer- (elen+ar lim3e re,ional yan, mem&esar lim3aenitis an salran lim3e yan, meraan, lim3an,itis. Ba(t yan, iperl(an se+a( mas(nya (man T *in,,a ter&ent(nya (omple(s primer seara len,(ap ise&t se&a,ai masa in(&asi T. al ini  &er&ea en,an pen,ertian masa in(&asi paa proses in3e(si lain- yait Da(t yan, iperl(an se+a( mas(nya (man *in,,a tim&lnya ,e+ala  penya(it. Masa in(&asi T &iasanya &erlan,sn, alam Da(t 4; min,, en,an rentan, Da(t antara '1' min,,. #alam masa in(&asi terse&t(man tm&* *in,,a menapai +mla* 10)104- yait +mla* yan, (p nt( meran,san, respons imnitas seller. Selama &ermin,,min,, aDal proses in3e(si- ter+ai pertm&*an lo,aritmi( (man T se*in,,a +arin,an t&* yan, aDalnya &elm tersensitisasi ter*aap t&erlin- men,alami per(em&an,an sensitiCitas. Paa saat ter&ent(nya (omple(s primer inila*- in3e(si T primer inyata(an tela* ter+ai. al terse&t itanai ole* ter&ent(nya *ipersensitiCitas ter*aap t&er(loprotein- yait tim&lnya respons positi3 ter*aap +i

30

t&erlin. Selama masa in(&asi- +i t&erlin masi* ne,ati3. Setela* (omple(s primer ter&ent(- imnitas seller t&* ter*aap T tela* ter&ent(. Paa se&a,ian &esar iniCi en,an system imn yan, &er3n,si  &ai(- &e,it system imn seller &er(em&an,- proli3erasi (man T ter*enti.  Namn- se+mla* (eil (man T apat tetap *ip alam ,ranloma. ila imnitas seller tela* ter&ent(- (man T &ar yan, mas( (e alam alCeoli a(an se,era imsna*(an. Setela* imnitas seller ter&ent(- 3os  primer i +arin,an par &iasanya men,alami resolsi seara semprna mem&ent( 3i&rosis ata (alsi3i(asi setela* men,alami ne(rosis per(i+an an en(apslasi. Kelen+ar lim3e re,ional +,a a(an men,alami 3i&rosis an en(apslasi- tetapi penyem&*annya &iasanya tia( sesemprna 3os primer  i +arin,an par. Kman T apat tetap *ip an menetap selama &erta*n ta*n alam (elen+ar ini. Komple(s primer apat +,a men,alami (ompli(asi. Kompli(asi yan, ter+ai apat ise&a&(an ole* 3os par ata i (elen+ar lim3e re,ional. %o(s primer i par apat mem&esar an menye&a&(an pnemonitis ata pleritis 3o(al. Ji(a ter+ai ne(rosis per(i+an yan, &erat- &a,ian ten,a* lesi a(an menair an (elar melali &ron(s se*in,,a menin,,al(an ron,,a i +arin,an par (aCitas. Kelen+ar lim3e *ils ata paratra(ea yan, mlanya &er(ran normal saat aDal in3e(si- a(an mem&esar (arena rea(si in3lamasi yan, &erlan+t. ron(s apat ter,an,,. >&str(si parsial paa &ron(s a(i&at te(anan e(sternal apat menye&a&(an ateleta(sis. Kelen+ar yan, men,alami in3lamasi an ne(rosis  per(i+an apat mersa( an menim&l(an erosi inin, &ron(s- se*in,,a menye&a&(an T eno&ron(ial ata mem&ent( 3istla. Massa (i+ apat menim&l(an o&str(si (omplit paa &ron(s se*in,,a menye&a&(an ,a&n,an pnemonitis an ateleta(sis- yan, serin, ise&t se&a,ai lesi se,mental (olaps(onsoliasi. Selama masa in(&asi- se&elm ter&ent(nya imnitas seller- apat ter+ai penye&aran lim3o,en an *emato,en. Paa  penye&aran lim3o,en- (man menye&ar (e (elen+ar lim3e re,ional mem&ent( (omple(s primer. Sean,(an paa penye&aran *emato,en(man T mas( (e alam sir(lasi ara* an menye&ar (e selr* t&*.

31

2anya penye&aran *emato,en inila* yan, menye&a&(an T ise&t se&a,ai  penya(it sistemi(. Penye&aran *amato,en yan, palin, serin, ter+ai aala* alam &ent(   penye&aran *emato,eni( tersamar olt *amato,eni sprea. Melali ara ini- (man T menye&ar seara sporai an sei(it emi sei(it se*in,,a tia( menim&l(an ,e+ala (linis. Kman T (emian a(an menapai  &er&a,ai or,an i selr* t&*. >r,an yan, &iasanya it+ aala* or,an yan, mempnyai Cas(larisasi  &ai(- misalnya ota(- tlan,- ,in+al- an par seniri- tertama ape(s par ata lo&s atas par. #i &er&a,ai lo(asi terse&t- (man T a(an &erepli(asi an mem&ent( (oloni (man se&elm ter&ent( imnitas seller yan, a(an mem&atasi pertm&*annya. #i alam (oloni yan, sempat ter&ent( an (emian i&atasi pertm&*annya ole* imnitas seller- (man tetap *ip alam &ent( ormant. %o(s ini mmnya tia( lan,sn, &erlan+t men+ai  penya(it- tetapi &erpotensi nt( men+ai 3os rea(tiCasi. %o(s potensial i ap(es par ise&t se&a,ai %o(s S!M>N. erta*nta*n (emian- &ila aya ta*an t&* pe+am menrn- 3os T ini apat 5 men,alami rea(tiCasi an men+ai penya(it T i or,an ter(ait- misalnya menin,itis- T tlan,- an lainlain. ent( penye&aran *amato,en yan, lain aala* penye&aran *emato,eni( ,eneralisata a(t ate ,eneraliAe *emato,eni sprea. Paa  &ent( ini- se+mla* &esar (man T mas( an &erear alam ara* men+ (e selr* t&*. al ini apat menye&a&(an tim&lnya mani3estasi (linis  penya(it T seara a(t- yan, ise&t T iseminata. T iseminata ini tim&l alam Da(t '6 &lan setela* ter+ai in3e(si. Tim&lnya penya(it  &er,antn, paa +mla* an Cirlensi (man T yan, &erear serta 3re(ensi  &erlan,nya penye&aran. T&er(losis iseminata ter+ai (arena tia(  ae(atnya system imn pe+am *ost alam men,atasi in3e(si Tmisalnya paa &alita. T&er(losis milier merpa(an *asil ari ate ,eneraliAe *emato,eni sprea en,an +mla* (man yan, &esar. Sema t&er(el yan, i*asil(an melali ara ini a(an mempnyai (ran yan, le&i* (ran, sama. !stili* milier &erasal ari ,am&aran lesi iseminata yan,

32

menyerpai &tr paipaian$+eDaDt millet see. Seara patolo,i anatomi(- lesi ini &erpa nol (nin, &er(ran 1) mm- yan, seara *istolo,i merpa(an ,ranloma. ent( penye&aran *emato,en yan, +aran, ter+ai aala* protrate *emato,eni sprea. ent( penye&aran ini ter+ai &ila sat 3os per(i+an menye&ar (e salran Caslar i e(atnya- se*in,,a se+mla* (man T a(an mas( an &erear i alam ara*. Seara (linis- sa(it T a(i&at  penye&aran tipe ini tia( apat i&ea(an en,an ate ,eneraliAe *emato,eni sprea. al ini apat ter+ai seara &erlan,. Paa ana(- 5 ta*n pertama setela* in3e(si tertama 1 ta*n pertama &iasanya serin, ter+ai (ompli(asi. Menrt Ball,ren- aa ) &ent( asar T  par paa ana(- yait penye&aran lim3o*emato,en- T eno&ron(ial- an T  par (roni(. Se&anya( 0.5)= penye&aran lim3o*emato,en a(an men+ai T milier ata menin,itis T- *al ini &iasanya ter+ai )6 &lan setela* in3e(si  primer. T&er(losis eno&ron(ial lesi se,mental yan, tim&l a(i&at  pem&esaran (elen+ar re,ional apat ter+ai alam Da(t yan, le&i* lama ) 9 &lan. Ter+ainya T par (roni( san,at &erCariasi- &er,antn, paa sia ter+ainya in3e(si primer. T par (roni( &iasanya ter+ai a(i&at rea(tiCasi (man i alam lesi yan, tia( men,alami resolsi semprna. Rea(tiCasi ini  +aran, ter+ai paa ana(- tetapi serin, paa rema+a an eDasa ma. T&er(losis e(straplmonal apat ter+ai paa '5)0= ana( yan, terin3e(si T. T tlan, an seni ter+ai paa 510= ana( yan, terin3e(si- an palin,  &anya( ter+ai alam 1 ta*n tetapi apat +,a ') ta*n (emian. T ,in+al  &iasanya ter+ai 5'5 ta*n setela* in3e(si primer.

Penegakkan Diagnosis Paru a$ Anamnesis

33

Pasien atan, en,an (el*an sala* sat ,e+ala respiratori( mapn sistemi( yait 1 "e+ala Respiratori( ,e+ala or,an yan, terli&at- &ent( ari ,e+ala ini  &erpa : a at( &era*a( V ' min,,  & at( #ara*  Sesa( napas  Nyeri aa "e+ala respiratori( ini san,at &erCariasi- ari mlai tia( aa ,e+ala sampai ,e+ala yan, (p &erat ter,antn, ari las lesi. Kaan,  penerita teria,nosis paa saat medical checkup. ila &ron(s &elm terli&at alam proses penya(it- ma(a penerita mn,(in tia( aa ,e+ala  &at(. at( yan, pertama ter+ai (arena iritasi &ron(s- an selan+tnya  &at( iperl(an nt( mem&an, a*a( (e lar. #+o+oi&roto- '009 "e+ala t&er(losis e(stra par ter,antn, ari or,an yan, terli&atmisalnya paa lim3aenitis t&er(losa a(an ter+ai pem&esaran yan, lam&at an tia( nyeri ari (elen+ar ,eta* &enin,- paa menin,itis t&er(losa a(an terli*at ,e+ala menin,itis- sementara paa pleritis t&er(losa terapat ,e+ala sesa( napas W (aan, nyeri aa paa sisi yan, ron,,a pleranya terapat airan. #+o+oi&roto- '009

' "e+ala sistemi(- "e+ala ini &erpa a #emam  & "e+ala sistemi( lain: malaise- (erin,at malam-anore(sia- &erat &aan menrn. '$ Pemeriksaan Fisik 

Paa pemeri(saan 3isi( pasien serin, tia( menn+(an sat (elainan  pn tertama paa (ass (ass ini ata seara asimptomati(. ila iri,ai aanya in3iltrat yan, a,a( las- ma(a iapat(an per(si yan, rep. Paa pasien en,an T par- (elainan yan, iapat ter,antn, las

34

(elainan. Paa aDal per(em&an,an penya(it slit item(an (elainan. Paa mmnya (elainan par terleta( i lo&s sperior tertama ape(s an se,men posterior S1 an S'- serta aera* ape(s lo&s in3erior S6. Teman yan, &isa iapat(an ari as(ltasi antara lain sara napas  &ron(ial- am3ori(- sara napas melema*- ron(i &asa*- tanatana  penari(an par- ia3ra,ma- an meiastimn. Soyo- '014

"am&ar 1: 2pe(s lo&s sperior an 2pe(s lo&s in3erior #+o+oi&roto- '009

($ Pemeriksaan Penun0ang 

1 Pemeri(saan Sptm

Paa t&er(losis par- &a*an pemeri(saan &a(teriolo,i &erasal ari a*a(. Pen,am&ilan a*a( ila((an minimal ' (ali en,an minimal sat (ali a*a( pa,i *ari. Pen,am&ilan se&anya( ) (ali le&i* ian+r(an. Pemeri(saan yan, (eti,a a(an &er,na se&a,ai &(ti (on3irmasi +i(a *anya sat ari a pemeri(saan aDal yan, mem&eri *asil positi3. Paa pela(sanaannya- ti,a spesimen a*a( i(mpl(an alam a *ari (n+n,an yan, &errtan yait a*a( SeDa(t  Pa,i   SeDa(t SPS.  Soyo- '014

35

S SeDa(t : #iam&il

saat

pasien

yan,

i,a

t&er(losis

 &er(n+n, pertama (ali. Kemian pasien i&e(ali pot a*a( ttp (nin, nt( pen,am&ilan a*a( (ea. P Pa,i

: Pasien iminta men,am&il a*a(nya i rma* paa pa,i *ari (ea setela* &an,n tir. Pot (emian isera*(an (e pet,as nit pelayanan (ese*atan paa *ari it +,a.

S SeDa(t : Pasien iam&il la,i a*a(nya saat pasien men,mpl(an a*a( pa,inya i *ari (ea yait sat *ari setela* (n+n,an pertama *ari (ea  Soyo- '014 Pasien perl ie(asi ara pen,am&ilan spesimen a*a( yan,  &enar. al*al yan, perl iper*ati(an aala* &a*Da sptm yan, iperl(an &erasal ari alam par se*in,,a (onsistensinya (ental an len,(et- &(an air la* ari mlt yan, (onsistensinya air. 2pa&ila  pasien tia( &er*asil mempro(si spitim setela* a (ali men,am&il napas alam. Ma(a ian+r(an nt( men,*irp ap air terle&i* a*l. #+o+oi&roto- '009 asil pemeri(saan a*a( iealnya iterima ole* o(ter yan, memeri(sa paa *ari yan, sama en,an *ari spesimen imas((an. Kesala*an ia,nosis apat menye&a&(an (esala*an pen,o&atan se*in,,a ia,nosis t&er(losis *ars ite,a((an en,an tepat. #+o+oi&roto- '009 lnterpretasi *asil pemeri(saan mi(ros(opi( ari ) (ali pemeri(saan iala* &ila : a ' (ali positi3- 1 (ali ne,ati3 X Mi(ros(opi( positi3   & 1 (ali positi3- ' (ali ne,ati3 X lan, T2 ) (ali - (emian  ila 1 (ali positi3- ' (ali ne,ati3 X Mi(ros(opi( positi3  ata &ila ) (ali ne,at3 X Mi(ros(opi( ne,ati3. erikut Alur Diagnosis T

36

"am&ar . 2lr #ia,nosis T #+o+oi&roto- '009 TEAPI PE!,ATA! T

!soniaAi !N- ri3ampisin- piraAinami- etam&tol- an streptomisin aala* lima o&at lini pertama nt( men,o&at t&erlosis. !soniaAi an ri3ampisin aala* o&at yan, palin, e3e(ti3. Kom&inasi isoniaAiri3ampisin yan, i&eri(an selama 9 &lan a(an menyem&*(an 959;= (ass t&erlosis yan, ise&a&(an ole* ,alr,alr rentan. Penam&a*an piraAinami (e (om&inasi isoniaAiri3ampisin selama ' &lan pertama memn,(in(an lama pen,o&atan i(ran,i men+ai 6 &an tanpa pen,ran,an e3i(asi. #alam pra(ti(- terapi imlai en,an re+men empat o&at &erpa isoniaAi- ri3ampisin- an piraAinami  pls etam&tol ata streptomisin sampai (erentanan isolat (linis i(eta*i. 8tam&tol ata streptomisin tia( menam&a* seara s&stensial a(tiCitas

37

(eselr*an re+imen- tetapi (eanya mem&eri perlinn,an tam&a*an +i(a isolat ter&(ti resisten ter*aap isoniaAi- ri3ampisin ata (eanya. PreCelensi resistensi isoniaAi i antara isolat (linis i ameri(a se(itar 10=. PreCelensi resistensi ter*aap isoniaAi an ri3ampisin. 1$ Isonia3i)

!soniaAi aal* o&at yan, palin, a(ti3 alam penan,anan t&erlosis a(i&at ,alr,alr yan, rentan. >&at ini aala* mole(l (eil M 1)7 yan, lart &e&as alam air. !n Citro- isoniaAi men,*am&at se&a,ian &esar &asil t&er(el paa (onsentrasi 0-' m,$ml ata (ran, an &a(teriasial nt( &asil t&er(el yan, a(ti3. >&at ini (ran, e3e(ti3 ter*aap spesies mi(o&a(teri atipi(al. !soniaAi menem&s (e alam ma(ro3a, an a(ti3 ter*aap mi(roor,anisme intrasel ata e(strasel. a$ +ekanisme ker0a )an )asar resistensi

!soniaAi men,*am&at pem&ent(an asam mi(olat- yan, merpa(an (omponen esensial penysn inin, sel &a(teri. !soniaAi aala* sat  pror, yan, ia(ti3(an Kat"- (atalasepero(siase mi(o&a(teri. !soniaAi yan, tela* a(ti3 mem&ent( sat (omple( (oCalen en,an sat protein  pem&aDa asil ayl arrier protein- 2pM an Kas2- sat &etaasil  pem&aDa sintetase- yan, men,*am&at pem&ent(an asam mi(olat an memati(an sel. Resistensi ter*aap isoniaAi &er(aitan en,an mtasi yan, menye&a&(an e(spresi &erle&i*an in*2- yan, men+ai sat &asil protein  pem&aDa re(tase epenen N2#Ymtasi ata elesi (at"Y mtasi  promotor yan, menye&a&(an mtasi promotor a*p- sat ,en Cirlensi yan, &erperan alam prote(si sel ari stres o(siati3Y an mtasi i (as2. asil yan, &anya( men,*asil(an in*2memperli*at(an resistensi isoniaAi era+at tin,,i an serin, tia( resisten silan, en,an etionami. Mtanmtan resisten o&at normalnya terapat alam poplasi mi(ro&a(teri rentan, en,an 3re(ensi se&esar 1 &asil alam 106. Karena lesi t&er(losis le&i* serin, men,ann, le&i* ari 10; &asil t&er(elmtanmtan resisten epat tersele(si +i(a pen,o&atan ila((an *anya

38

en,an isoniaAi ata o&at lain se&a,ai terapi tn,,al. Pema(aian a o&at yan, inepenen alam (om&inasi a(an +a* le&i* e3e(ti3. Kemn,(inan  &a*Da se&a* &asil paa aDalnya resiten ter*aap (ea o&at aala* se(ita 1 alam 106106- ata 1 alam 101'- &e&erapa (ali lipat le&i* &esar  aripaa +mla* or,anisme yan,men,in3e(si. Karena it- palin, sei(it o&at a(ti3 *ars selal i,na(an nt( men,p&ati t&erlosis a(ti3 nt(  mene,a* mnlnya resistensi selama pen,o&atan. '$ Farmakokinetik 

!soniaAi ma* iserap ari salran erna. #osis oral )00 m, 5 m,$(,  paa ana( me&apai (onsentrasi plasma pna( )5 m($mL alam 1'  +am. !soiaAi epat &eri3si (e alam sema airan an +arin,an t&*. Konsentrasi i ssnan sara3 psat an airan sere&rospinal &er(isar '0= an 100= ari (onsentrasi serm paa saat yan, sama. Meta&olisme isoniaAi- (*ssnya asetilasi ole* Nasetiltra3erase *atiitent(a seara ,enetis. Konsentrasi plasma rerata isoniaAi paa asetilator  epat aala* se(itar seperti,a sampai separ* i&anin,(an en,an paa asetilator lam&at- an seDa(t par* rerata masin,masin, aala* (ran, ari 1 +am ata ) +am. Klirens isoniaAi yan, le&i* epat ole* asetilator  epat &iasanya tia( menim&l(an (onse(ensi terapeti( yan, &erma(na  +i(a osis *arian tela* sesai- tetapi apat ter+ai (onsentrasi s&terapeti(   +i(a o&at i&eri(an se&a,ai osis se(ali semin,, ata +i(a terapat mala&ror&si. Meta&olit isoniaAi an +mla* (eil o&at yan, tia( &er&a* ie(s(resi(an tertama i rin. #osis tia( perl isesai(an paa ,a,al ,in+al. Paa pasien en,an ins3siensi *ati yan, para*- penyesaian osis  &elm i(te*i pasti an seyo,yianya itent(an ole* (onsentrasi serm  +i(a ipertim&an(an pen,ran,an osis.



Pemakaian klinis

39

#osis laAim isoniaAi aala* 5m,$(,$*ariY oss eDasa &iasanya aala* )00 m, yan, i&eri(an se(ali se*ari.
eaksi samping

!nsien an (epara*an rea(si yan, tia( iin,in(an ter*aap isoniaAi  &er(aitan en,an osis an lama pem&erian. i.

ii.

Rea(si imnolo,i(  #emam an ram (lit (aan, ter+ai. Perna* ilapor(an lps eritemetoss sistemi( im&aso&at. To(sisitas lan,sn, epatitis im&asisoniaAi merpa(an e3el to(si( terserin,. al ini  &er&ea ari pen,(atan rin,an aminotran3erase *ati *in,,a ti,a ata empat (ali lipat i&anin,(an normal- yan, tia(  men,*ars(an pen,*entian o&at an i+mpai paa 10'0= pasienyan, &iasanya asimtomati(. epatitis (linis &iasnaya iserta malmnta*- *ilan,nya na3s ma(an- i(ters- an nyeri (aran (anan atas paa 1= pasien yan, i&eri isoniaAi an memati(an- tertama  +i(a o&at tia( se,era i*enti(an. Terapat &(ti *istolo,i(  (ersa(an an ne(rosis *epatoseller. Resi(o *epatitis &er,antn,  paa sia. 83e( sampin, ini +aran, ter+ai paa sia i&aDa* '0 ta*n- paa 0-)= ari mere(a yan, &ersia '1)5ta*n- 1-'= paa mere(a yan, &ersia )650 ta*n- an '-)= paa mere(a yan,  &ersia 50 ta*n ata le&i*. Resi(o *epatitis le&i* &esar paa oran,

40

en,an (eter,antn,an al(o*ol an mn,(in selama masa (e*amilan an perioe pasa parts ter+ainya *epatitis isoniaAi merpa(an (ontraini(asi pema(aian le&i* lan+t o&at.  Neropati peri3er iamati paa 10'0= pasien yan, i&eri osis le&i* ari 5 m,$(,$*ari- tetapi +aran, i+mpai paa osis eDasa )00m,.  Neropati peri3er le&i* &esar (emn,(inan ter+ai paa asetilator lam&at an pasien en,an preisposisi seperti malntrisi- al(o*olisme- ia&etes2!#S an remia. Neropati peri3er ter+ai (arena e3isiensi relati3   pirio(sin. !soniaAi menoron, rea(si pirio(sin- an to(sisitas ini ma* iatasi en,an pem&erian pririo(sin en,an osis 10m,$*ari. To(sisitas SSP &er(ran,nya aya in,at- psi(osis- an (e+an,. 83e(e3e( ini &erespon ter*aap pirio(sin. er&a,ai rea(si lain +,a apat ter+ai seperti (elainan *ematolo,i( proCo(asi anemia e3isiensi pirio(sin- tinits- an ,an,,an penernaa. !soniaAi apat men,ran,i meta&olisme 3enitoin- menin,(at(an (aar an to(sisitas o&at ini. 2$ i#ampisin

Ri3ampisin aala* sat trnan simisinteti( ri3ampisin sat anti&ioti(  yan, i*asil(an ole* Streptomyces mediterrenei. >&at ini in Citro a(ti3 ter*aap (o(s positi3,ram an ne,ati3,ram- &e&erapa &a(teri ss an mi(o&a(terian (lamiia. >r,anisme yan, rentan a(an i*am&at ole* (onsentrasi (ran, ari 1 m,$mL. Mtan resisten ter*aap i sema poplasi mi(o&a(teri se(itar  1 ari 106 or,anisme an epat tersele(si +i(a ri3ampisin i,na(an se&a,ai o&at tn,,al- (*ssnya paa pasien en,an in3e(si a(ti3. Tia( terapat resistensi silan, en,an o&at antimi(ro&a ,olon,an lain- tetapi terapat resistensi silan, en,a trnan ri3ampisin lain mis. Ri3a&tin an ri3apentin.

a$ +ekanisme ker0a reistensi )an #armakokinetik 

41

Ri3ampisin men,i(at s&nit RN2 polimerase epenen #N2 &a(teri an (arena nya men,*am&at pem&ent(aan RN2. Resitensi ter+ai melali sat ari &e&erapa (emn,(ianan mtasi titi( i rpo- ,en nt( s&nit RN2 polimerasi. Mtasmtasi ini menye&a&(an &er(ran,nya pein,(atan ri3ampisin (e RN2 polimerase. RN2 polimerase mansia tia( tia(  men,i(at ri3ampin an tia( men,a*m&at ole*nya. Ri3ampin &ersi3at  &a(teriasial &a,i mi(ro&a(teria. >&at ini ma* menem&s se&a,ian &esar   +arin,an an mas( (e alam sel 3a,isit. Ri3ampin apat memati(an or,anisme yan, slit ia(ses ole* &anya(o&at lain.- misalnya or,anisme yan, terapat i alam a&ses an (aCitas par. Ri3ampin iserap en,an &ai( setela* pem&erian olral an ie(s(resi(an meali *ati (e alam empe. >&at ini (emian men,alami resi(lasi entero*epati(- en,an se&a,ian &esar ie(s(resi(an se&a,ai meta&olit ealisasi i tin+a an se&a,ian (eil ie(s(resi(an i rin. Tia(  iperl(an penyesain osis an ins3isiensi ,in+al an *ati. #osis laAim a(an men,*asil(an (aar serm 57 m$ml. Ri3ampin teritri&si las i airan an +arin,an t&*. >&at ini relati3 &anya( teri(at (e protein an (onsntrasi yan, ae(at i SS *anya terapai +i(a terapat peraan,an menin,en.  &

Pemakaian klinis

Ri3ampin &iasanya 600 m,$(,$*ari 10m,$(,$*ari per oral- *ars i&eri(an &ersama isoniaAi ata o&at anti t&er(losa ian nt(pasien en,an pasien T& a(ti3 nt( mene,a* ter+ainya mi(o&a(teri resisten o&at. Paa &e&eapa terapi +an,(a pene( ri3ampin 600 m, per *ari ata '(ali semin,, selama 6 &lan- +,a e3e(ti3 alam (om&inasi en,an o&at lain paa &e&erapa in3e(si mi(o&a(teri atipi( an paa (sta. 

In)ikasi lain

Ri3ampin i,ana(n paa in3e(si &a(teri lain. Se&a,ai osis oral 600 m, a (ali se*ari selama ' *ari- o&at ini apat men,*ilan,(an

42

 pen,an,(t$pem&aDa menin,o(o(s. Ri3ampin- '0 m,$(,$*ari selama 4 *ari i,na(an se&a,ai pro3ila(sis. 

eaksi "amping

Ri3ampin menye&a&(an Darna oran,e paa rin- air mata an (erin,at yan, tia( mem&a*aya(an. 83e( sampin, yan, lain aala* ramtrom&ositipeni- an ne3ritis. Ri3ampin apat menye&a&(an i(ters (olestati(. %$ Etam'utol a$ +ekanisme Ker0a Dan Pemakian Klinis

"alr,alr Mycobacterium tuberculosis an mi(o&a(terim lain yan, rentan i*am&at in Citro ole* etam&tl 15 m,$mL. 8tam&tol men,*am&at ara&inosil trans3erase mi(o&a(teri- yan, isani ole* operan em&2. 2ra&inosil trans3erase &erperan alam rea(si polimerasi ara&ino,li(an- sat (omponen esensial ari inin, sel mi(o&a(teri. Resistensi ter*aap etam&tol ise&a&(an ole*mtasi yan, menye&a&(an e(spresi &erle&i*an pro(pro( ,en em& ata i str(tr em&. '$ eaksi samping

ipersensitiCitas ter*aap etam&tol +aran, ter+ai. 83e sampin, seris terserin, aala* neritis retro&l&ar- yan, menye&a&(an *ialn,nya (eta+aman pen,li*atan an &ta Darna *i+amera*. 83e( sampin, ter(ait osis ini le&i* serin, ter+ai paa osis '5m,$(,$*ari. &$ Pira3inami) a$ +ekanisme Ker0a Dan Pemakaian Klinis

PiraAinami i&a* men+ai asam piraAinoat&ent( a(ti3 o&at ole*  piraAinamiase mi(o&a(teri yan, isani ole* pn2. Tar,et spesi3i( o&at ini &elm i(eta*i- tetapi asam piraAinoat men,an,, meta&olisme mem&ran sel mi(o&a(teri an 3n,si transornya. Resistensi mn,(in ise&a&(an ole* ,an,,an penyerapan piraAinami ata pn2 yan, men,a*m&at per&a*an piraAinami men+ai &ent( a(ti3nya

43

'$ eaksi "amping

83e( sampin, tama piraAinami aala* *epatoto(sisitas paa 15=  pasien- mal- mnta*- emam o&at an *iperresemia. Ian, tera(*ir  ter+ai seara merata an &(an merpa(an a(asan nt( men,*enti(an  pen,o&atan. i&erresemia apat memi artritis ,ot a(t. 5$ "treptomisin

Streptomisin sl3at i,na(an ata iin,in(an o&at snti( an alam  pen,o&atan in3e(si yan, resisten ter*aap o&at lain. #osis laAim nt( eDasa aala* 15m,$(,$*ari. Streptomisin &ersi3at ototo(si( an ne3rotosi(. Eeri,o an penrnan  penen,aran aala* e3e( sampin, terserin, an mn,(in permanen. To(sisitas  &er(aitan en,an osis- an resi(o menin,(at paa pasien lan+t sia. Seperti sema amino,li(oseri lainya- osis *ars isesi(an &erasar(an 3n,si ,in+al.

Penatalaksanaan Kasus )an Pem'a-asan Dengan +eto)e "AP 1. "u'0ekti# 

 Nama

: Tn M

 No. RM

: '70919;9

TTL

: '0 Maret 1970

Jenis Kelamin

: La(i  la(i

MRS

: !"# $ 1; %e&rari '016 p(l: ').00

Kel*an

: sesa( na3as an &at( /- emam / semalamT - #M  - Jantn,  - Stro(e - 2sma /

#

: T

44

'.

'0e(tie

#ata Klini( Pasien: K< T# R RR S*

Tampa( lemas an pat 1)0$;0 mm, 100 $ menit '; $ menit )6-7o 

#ata La&oratorim Pasien  Nilai Normal & 1)-)  16-' L8# 0  15 Le(osit 5.000  11.000 sel$mm ) Pemeri(saan T2 Ne,atiCe

1;$' 1'-7 1 +am '0 menit 10.710 sel$mm) Positi3  

).

Pasien : T Pro&lem Meis : Sesa( Na3as an at( Pro(ti3  Tan,,al 1;$'

S&+etiCe at(  

>&+e(ti3 Sptm T2 /

2ssesment T

 pro(ti3  Sesa( na3as

>nset ' &lan Respirasi menin,(at

2sma

RiDayat asma /

4.

Plan

Resimen Pen,o&atan Metoe #>TS #ep(es R! '011 Kate,ori 1 Sptm T2 / ar

%ase 2Dal 'RHS RH8 'RHS RH8

%ase Lan+tan 4 )R) 6 8

Assesmen t

#ia,nosa

45

ent( T erat 'RHS RH8 T 8(stra Par 'RHS RH8 T2  - %oto t*ora 'RHS RH8

4 R  

/ #osis >&at  Nama >&at

#osis  m,  %ase aDal

%ase lan+tan

!soniaAi

)00

600

Ri3ampisin

450

450

PiraAinami

500

-

8tam&tol

'50

-

Z2pa&ila alam ' &lan 3ase intensi3- T2 masi* positi3- ma(a 3ase intensi3 iperpan+an, selama 4 min,,