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DALAM PRAKTEK KEDOKTERAN GIGI Drg. Yayun Siti Rochmah SpBM
Medication risk factors for drug interactions include Use of drugs that are highly protein bound Use of drugs with a narrow margin of safety that require frequent blood level testing Chronic drug therapy - drugs that induce or inhibit hepatic microsomal enzymes
Patient risk factors for drug interactions include very young and elderly (metabolisms are different) Male versus female Comorbid illness (patients with many illnesses) decreased liver and kidney function .
There are five main interactions: Pharmacokinetic Pharmacodynamic Addition Synergism Antagonism .
However.PHARMACOKINETIC Interaction is a change in the pharmacokinetics of one drug caused by the interacting drug. . this occurs less often than an increase in pH causes an increase in absorption. In this case a gap of two to four hours between taking the two drugs is usually sufficient to avoid the interaction. tipranavir (25%) and amprenavir (up to 35%). In the case of the antacids. an increase in pH can inhibit the absorption of other drugs such as zalcitabine (absorption can be decreased by 25%). Such as occurs when cimetidine is taken with didanosine.
which trigger compensation mechanisms thereby increasing blood glucose levels. the body will not adopt corrective mechanisms and there will be an increased risk of a serious reaction resulting from the ingestion of both drugs at the same time. and also be taking another drug such as certain beta-blockers for heart disease. Should a patient be taking a drug such as insulin. which reduces glycaemia. . it is known that hypoglycaemia (low blood glucose) in an organism produces a release of catecholamines. then the beta-blockers will act to block the adrenaline receptors. Therefore.PHARMACODYNAMIC Interaction is a change in the pharmacodynamics of one drug caused by the interacting drug For example. which allows the organism to recognise what is happening and which act as a stimulant for preventative action (eating sugars). The release of catecholamines also triggers a series of symptoms. This will block the reaction triggered by the catecholamines should a hypoglycaemic episode occur.
ADDITION interaction is the effect of two or more drugs when administered together is the same as if the drugs were given seperately Clavulanat acid with amoxicillin .
anabolic steroid. may produce responses equivalent to over dosage Memberikan efek yang sinergis atau antagonis karena mengikat reseptor yang sama sehingga mempengaruhi system fisiologi Meningkatkan efek obat antidiabet disebabkan karena penggunaan salisilat. dan non selektif MAOIs .SYNERGISM Interaction is the effect of two or more drugs when administered together is greater than if the drugs were given seperately.
dan kontrasepsi oral .ANTAGONIST interaction is the effect of two or more drugs when administered together is less than when the drugs are given seperately. korikosteroid. Penicillin (bactericidal antibiotic) and azithromycin (bacteriostatic antibiotic) is an example of Memberikan efek antagonis jika obat anti diabetes digunakan dengan diuretic tiazid. diazoxide.
alcohol .caffeine .DRUG-FOOD INTERACTIONS INCLUDE .dairy products /calcium foods .Grapefruit juice .
Because codeine and tramadol are prodrugs. quinolone antibiotics such as ciprofloxacin inhibit the metabolism of CYP1A2 substrates. including alcohol. CYP2D6 (codeine and tramadol). . recent research suggests that concomitant alcohol intake does not increase the hepatotoxic potential of therapeutic doses of acetaminophen. CYP3A4 (methylprednisolone) and CYP2E1 (acetaminophen). Other dental therapeutic agents are substrates for CYP2C9 (celecoxib. inhibition of their metabolism can lead to a diminution of their analgesic effects. The antibiotics erythromycin and clarithromycin are potent inhibitors of CYP3A4 and can increase blood levels and toxicity of CYP3A4 substrates. theoretically can increase the proportion of it that is biotransformed into a potentially hepatotoxic metabolite. ibuprofen and naproxen). While inducers of acetaminophen metabolism.
Evidence of potential interactions with local anaesthetic dental preparations comes mainly from anecdotal case reports documented many years ago. prilocaine. either adrenaline (epinephrine) or felypressin. when doses used were much higher than those recommended today.LOCAL ANAESTESIA INTERACTION The amide local anaesthetics most commonly used for dental procedures in primary care are lidocaine. This Q&A explores the clinical significance of potential interactions between dental local anaesthetic preparations and other medicines as listed in the BNF and SmPCs. It does not cover the use of local anaesthetics in patients with medical conditions that may contraindicate or require caution in their use. . The majority of local anaesthetic dental cartridges also contain a vasoconstrictor. Reports of serious drug interactions associated with currently recommended doses of local anaesthetics and vasoconstrictors in the dental setting are exceedingly rare . articaine and mepivacaine.
750mg intravenously over 24 hours . Some agents e. the manufacturer has an obligation to include this information in the product literature. lidocaine. lidocaine is used in doses of up to 1. .LOCAL ANAESTESIA INTERACTION Interactions listed in the BNF are usually only relevant when the local anaesthetics/vasoconstrictor are used at high doses or for specific indications other than dental anaesthesia. Although many of the listed interactions are either theoretical and may not have been seen in dental practice or are relevant to much higher doses used for different indications. Theoretical interactions are often included in SmPCs if they have previously occurred with medicines that have similar pharmacological actions. are used for purposes other than local anaesthesia.g. As a treatment for arrhythmia.
The use of local anesthetics.LOCAL ANAESTESIA WITH SEDATIVE Local anesthesia and preoperative oral sedative/anxiolytic therapy often are indicated for routine oral surgery and restorative dentistry. sedatives or anxiolytic agents in combination with other central nervous system depressant agents or in combination with drugs that inhibit their metabolism was associated with a few serious adverse drug interactions or complications. .
HUBUNGAN OBAT SISTEMIK DENGAN TERAPI KEDOKTERAN GIGI .
dan peringatan.PROSES TERAPI RASIONAL Langkah 1: Tetapkan masalah pasien Langkah 2: Tentukan tujuan terapi . Langkah 3: Teliti cocok tidaknya terapi-P Anda untuk pasien ini. cara pakainya. Apa yang ingin anda capai dengan terapi tersebut. Periksalah apakah terapi itu manjur dan aman. Langkah 4: Mulailah pengobatan Langkah 5: Berikan penjelasan tentang obat . Langkah 6: Pantau (hentikan ) pengobatan 16 .
PENYAKIT JANTUNG Jantung kongenital Jantung dapatan Hipertensi .
• STENOSIS DAN ATRESIA ARTERI PULMONALIS. Fausto. Transposition of the great arteries) • TRUNKUS ARTERIOSUS • KOARKTASIO AORTA. 2 ANOMALI KONGENITAL OBSTRUKTIF Mitchell. Abbas. Dasar Patologis Penyakit . • STENOSIS DAN ATRESIA AORTA. Kumar.KLASIFIKASI PENYAKIT JANTUNG KONGENITAL TIPE SHUNT DARI KIRI KE KANAN (PENYAKIT JANTUNG KONGENITAL ASIANOTIK) 1 ANOMALI KONGENITAL TIPE SHUNT SHUNT DARI KANAN KE KIRI (PENYAKIT JANTUNG KONGENITAL SIANOTIK) KELAINAN • DEFEK SEPTUM ATRIUM (ASD) • DEFEK SEPTUM VENTRIKEL (VSD) • DUKTUS ARTERIOSUS PATEN (PDA) • TETRALOGI OF FALLOT • TRANSPOSISI ARTERI BESAR (TGA .
Colpidogrel Resiko subakut endokarditis (SBE) .JANTUNG KONGENITAL Perlu profilaksis antibiotika Waspada Aspirin.
JANTUNG DAPATAN Perlu profilaksis antibiotika Waspada Aspirin. walfarin . Colpidogrel Heparin.
sebaiknya obat-obat tersebut dihentikan antara 5-7 hari setelah mendapatkan ijin dari dokter spesialis yang terkait (jantung atau penyakit dalam) .PENATALAKSANAAN ? Bila pasien akan dilakukan tindakan dibidang kedokteran gigi.
PENYAKIT AUTOIMUNE AIDS.HIV Infection and related condition Allergy Rheumatologic and connective tissue disorders Organ and bone marrow transplantation .
WASPADA Kortikosteroid jangka panjang Perlu profilaksis antibiotika Perlu terapi antibiotika post tindakan bedah Perlu terapi roborontia .
HAL YANG HARUS DIPERHATIKAN PADA PASIEN DENGAN CKD Adanya hipertensi Anemia oleh karena kurangnya produksi erithropoeitin Tendensi bleeding oleh karena trombisitopenia Penggunaan obat obatan yang non Nefrotoxic Status nutrisi Histori dari Cardiac disease .
DENTAL DRUG METABOLIZED PRIMERILY BY THE LIVER Local anesthetics (appear safe for use during liver disease when used in appropiate amounts) Lidocaine (xylocaine) Mepivacain e(carbocaine) Prilocaine ( Citanest) Bupivacaine ( Marcaine) Analgesics Aspirin Acetaminophen Codeine Meperidine Ibuprofen Sedatives Diazepam Barbiturates Antibiotics Clindamycin Eritromycin Ampicillin Tetracycline Metronidazole Vancomycin .
DENTAL DRUG METABOLIZED PRIMERILY BY THE KIDNEY Analgesik Aspirin Propoxyphen Anestesi lokal Lidocain Antibiotika Amoxicillin/ penicillin V Cephalexin Metronidazol Tetracyclin .
Antibiotika kontrasepsi Antibiotika NSAID Antibiotika warfarin Asma NSAID .
amlodipine.HIPERTENSI Diuretic : Ex : furocemide Beta blocker : Ex : propanolol Alpha blocker : Ex :terazocin Ca channel blocker . nifedipin ACE inhibitor: Ex : captopril. Ex . enalapril Angiotension II reseptor antagonis : Ex : valsartan Aldosteron antagonis : spironolactone (heart failure) .
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